15 research outputs found
Travelling beyond the current frontiers: Perioperative and long-term cardiac risk assessment and management of patients undergoing major vascular surgery
In this thesis, the prognostic value of clinical risk factors, the use of
noninvasive testing for risk stratification, and pharmacologic risk reduction strategies
are described for the perioperative and long-term management of patients
undergoing major vascular surgery
A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery
OBJECTIVE: To evaluate the discriminatory value and compare the predictive
performance of six non-invasive tests used for perioperative cardiac risk
stratification in patients undergoing major vascular surgery. DESIGN:
Meta-analysis of published reports. METHODS: Eight studies on ambulatory
electrocardiography, seven on exercise electrocardiography, eight on
radionuclide ventriculography, 23 on myocardial perfusion scintigraphy,
eight on dobutamine stress echocardiography, and four on dipyridamole
stress echocardiography were selected, using a systematic review of
published reports on preoperative non-invasive tests from the Medline
database (January 1975 and April 2001). Random effects models were used to
calculate weighted sensitivity and specificity from the published results.
Summary receiver operating characteristic (SROC) curve analysis was used
to evaluate and compare the prognostic accuracy of each test. The relative
diagnostic odds ratio was used to study the differences in diagnostic
performance of the tests. RESULTS: In all, 8119 patients participated in
the studies selected. Dobutamine stress echocardiography had the highest
weighted sensitivity of 85% (95% confidence interval (CI) 74% to 97%) and
a reasonable specificity of 70% (95% CI 62% to 79%) for predicting
perioperative cardiac death and non-fatal myocardial infarction. On SROC
analysis, there was a trend for dobutamine stress echocardiography to
perform better than the other tests, but this only reached significance
against myocardial perfusion scintigraphy (relative diagnostic odds ratio
5.5, 95% CI 2.0 to 14.9). CONCLUSIONS: On meta-analysis of six
non-invasive tests, dobutamine stress echocardiography showed a positive
trend towards better diagnostic performance than the other tests, but this
was only significant in the comparison with myocardial perfusion
scintigraphy. However, dobutamine stress echocardiography may be the
favoured test in situations where there is valvar or left ventricular
dysfunction
Which Stress Test is Superior for Perioperative Cardiac Risk Stratification in Patients Undergoing Major Vascular Surgery?
AbstractObjective: to compare the additional prognostic value of Dobutamine Stress Echocardiography (DSE), Dipyridamole Stress Echocardiography (DiSE) and Perfusion Scintigraphy (DTS) on clinical risk factors in patients undergoing major vascular surgery.Design: retrospective analysis.Materials: 2204 consecutive patients who underwent DSE (n=1093), DiSE (n=394), or DTS (n=717) testing before major vascular surgery were studied.Methods: primary endpoint was a composite of cardiac death and non-fatal myocardial infarction (MI). Logistic regression analysis was performed to evaluate the relation between cardiac risk factors, stress test results and the incidence of the composite endpoint.Results: there were 138 patients (6.3%) with cardiac death or MI. Patients with 0, 1–2, and 3 or more risk factors experienced respectively 3.0, 5.7 and 17.4% cardiac events. We found no statistically significant difference in the predictive value of a positive test result for DiSE and DSE (Odds ratio (OR) of 37.1 [95% CI, 8.1–170.1] vs 9.6 [95% CI, 4.9–18.4]; p=0.12), whereas a positive test result for DTS had significantly lower prognostic value (OR=1.95 [95% CI, 1.2–3.2]).Conclusion: a result of stress echocardiography effectively stratified patients into low- and high-risk groups for cardiac complications, irrespective of clinical risk profile. In contrast, the prognostic value of DTS results was more likely to be dependent on patients' clinical risk profile