Seeger J M, Rosenthal G R, Self S B, Flynn T C, Limacher M C, Harward T R
Department of Surgery, University of Florida, Gainesville.
Ann Surg. 1994 Jun;219(6):654-61; discussion 661-3. doi: 10.1097/00000658-199406000-00008.
Prophylactic cardiac revascularization in patients with ischemic myocardium could reduce postoperative cardiac complications after aortic reconstruction. However, the effectiveness of this approach has not been documented.
Stress-thallium scanning can identify patients with ischemic myocardium. Morbidity and mortality after aortic reconstruction appears to be largely caused by co-existent coronary artery disease, and patients who have had recent cardiac revascularization have few postoperative cardiac complications.
Preoperative stress-thallium scanning was evaluated prospectively in 146 patients undergoing aortic reconstruction. Patients with positive studies underwent coronary arteriography and cardiac revascularization, when appropriate. Postoperative cardiac complications and long-term survival in these patients were compared with results from 172 similar patients undergoing aortic reconstruction without stress-thallium scanning. Results also were analyzed to determine predictors of postoperative cardiac events.
Forty-one per cent of patients undergoing stress-thallium testing underwent coronary arteriography, and 11.6% had cardiac revascularization. In contrast, 14.7% of patients treated without stress-thallium testing had coronary arteriography, and 4.1% had revascularization (p < 0.01). Despite this, cardiac mortality, serious cardiac complications, and long-term cardiac mortality were similar in both groups. Only advanced age and intraoperative complications (but not a positive stress-thallium test) predicted postoperative cardiac events.
Preoperative stress-thallium testing confirmed a high incidence of significant coronary artery disease in patients undergoing aortic reconstruction, but prophylactic cardiac intervention does not reduce operative or long-term mortality. Thus, the risk and expense of routine stress-thallium testing and subsequent cardiac revascularization cannot be justified.
对缺血心肌患者进行预防性心脏血运重建可降低主动脉重建术后的心脏并发症。然而，这种方法的有效性尚未得到证实。
负荷心肌灌注显像可识别缺血心肌患者。主动脉重建术后的发病率和死亡率似乎很大程度上由并存的冠状动脉疾病引起，近期接受心脏血运重建的患者术后心脏并发症较少。
对146例接受主动脉重建的患者进行前瞻性负荷心肌灌注显像评估。检查结果呈阳性的患者在适当情况下接受冠状动脉造影和心脏血运重建。将这些患者的术后心脏并发症和长期生存率与172例未进行负荷心肌灌注显像的类似主动脉重建患者的结果进行比较。还对结果进行分析以确定术后心脏事件的预测因素。
接受负荷心肌灌注显像检查的患者中有41%接受了冠状动脉造影，11.6%进行了心脏血运重建。相比之下，未进行负荷心肌灌注显像检查的患者中有14.7%接受了冠状动脉造影，4.1%进行了血运重建（p<0.01）。尽管如此，两组的心脏死亡率、严重心脏并发症和长期心脏死亡率相似。只有高龄和术中并发症（而非负荷心肌灌注显像检查阳性）可预测术后心脏事件。
术前负荷心肌灌注显像证实接受主动脉重建的患者中显著冠状动脉疾病的发生率很高，但预防性心脏干预并不能降低手术死亡率或长期死亡率。因此，常规负荷心肌灌注显像检查及随后心脏血运重建的风险和费用是不合理的。
