Prediction of early cardiac morbidity and mortality following aorto-iliac reconstruction: comparison between clinical scoring systems, echocardiography and dipyridamole-thallium scanning.

Preoperative cardiac assessment may be difficult in patients with aorto-iliac and/or peripheral vascular disease because of severe physical limitation due to the disease itself, advanced age, locomotor problems or because of beta-blocker usage. 216 patients with aorto-iliac occlusive disease were studied; several cardiac risk scoring systems were determined for each patient. Preoperative echocardiography was performed in 182 patients and thallium-scanning in 63 patients. The results from the preoperative risk factor evaluations, echocardiographies and thallium examinations were correlated individually with the postoperative observed cardiac complications. Overall mortality was 2.8% (4 patients died from myocardial infarction). A total of 13 major postoperative cardiac events (10 myocardial infarctions and 3 life-threatening arrhythmias) were registered. No statistical correlation could be identified between the patient's clinical examination nor the scoring system and the occurrence of postoperative cardiac complications. 12 events occurred out of 13 patients who were shown to have a reversible defect on the preoperative thallium scan. These patients also presented hypokinesia or akinesia on the preoperative echocardiography. Thallium imaging and echocardiography represent a valid preoperative test to evaluate the risk of cardiac morbidity and mortality in vascular patients. Coronary angiography is recommended in patients suffering from progressive and/or unstable angina.