Suggs W D, Smith R B, Weintraub W S, Dodson T F, Salam A A, Motta J C
Department of Surgery, Emory University, School of Medicine, Atlanta.
J Vasc Surg. 1993 Sep;18(3):349-55; discussion 355-7.
The purpose of this study was to retrospectively evaluate the effectiveness of screening for coronary artery disease before elective repair of abdominal aortic aneurysms (AAA) was performed.
Results of a screening algorithm for coronary artery disease in 263 patients admitted to a single hospital for elective repair of AAA between January 1986 and December 1989 were analyzed. Patients with no coronary artery disease indicators proceeded to surgery without further workup. Patients with cardiac disease indicators underwent dipyridamole-thallium scintigraphy, and patients with angina were screened by use of cardiac catheterization; those with a recent coronary revascularization underwent no additional screening unless symptoms or electrocardiographic changes suggested an intervening event. Twenty-eight patients underwent no screen other than medical history and electrocardiogram.
Among 164 patients screened with dipyridamole-thallium scintigraphy, 44 patients had redistribution defects that required catheterization, and 11 of these underwent coronary revascularization. Cardiac catheterization was performed directly in 42 patients, which led to 11 revascularizations before AAA repair. Previous coronary artery bypass or percutaneous transluminal angioplasty obviated additional screening in 29 patients. Of the 263 scheduled AAA repairs, 15 were cancelled because of unacceptable operative risks, 13 for cardiac reasons. One patient died of a ruptured AAA after an uneventful coronary artery bypass. Among the 247 AAA repairs performed, there were three perioperative deaths (1.2%), all of which resulted from sudden cardiac events; three additional patients had nonfatal myocardial infarctions (1.2%), for a total cardiac complication rate of 2.4%.
The low rate of cardiac complications in this experience affirms the effectiveness of preoperative screening and selective coronary revascularization before AAA repair.
本研究旨在回顾性评估在择期修复腹主动脉瘤（AAA）之前进行冠心病筛查的有效性。
分析了1986年1月至1989年12月期间在一家医院接受择期AAA修复的263例患者的冠心病筛查算法结果。无冠心病指标的患者无需进一步检查即可进行手术。有心脏病指标的患者接受双嘧达莫 - 铊闪烁扫描，心绞痛患者通过心脏导管检查进行筛查；近期进行过冠状动脉血运重建的患者，除非有症状或心电图改变提示有介入事件，否则不再进行额外筛查。28例患者除病史和心电图外未进行其他筛查。
在164例接受双嘧达莫 - 铊闪烁扫描的患者中，44例有再分布缺陷，需要进行导管检查，其中11例接受了冠状动脉血运重建。42例患者直接进行了心脏导管检查，其中11例在AAA修复前进行了血运重建。既往冠状动脉搭桥或经皮腔内血管成形术使29例患者无需额外筛查。在计划进行的263例AAA修复中，15例因不可接受的手术风险而取消，13例因心脏原因取消。1例患者在冠状动脉搭桥手术顺利后死于AAA破裂。在进行的247例AAA修复中，有3例围手术期死亡（1.2%），均由心脏突发事件导致；另外3例患者发生非致命性心肌梗死（1.2%），心脏并发症总发生率为2.4%。
本研究中心脏并发症发生率低，证实了术前筛查和AAA修复前选择性冠状动脉血运重建的有效性。
