Document Detail


Does routine stress-thallium cardiac scanning reduce postoperative cardiac complications?
MedLine Citation:
PMID:  8203974     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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. SUMMARY BACKGROUND DATA: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors:
J M Seeger; G R Rosenthal; S B Self; T C Flynn; M C Limacher; T R Harward
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  219     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-07     Completed Date:  1994-07-07     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  654-61; discussion 661-3     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Florida, Gainesville.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Diseases / complications,  surgery*
Coronary Angiography
Exercise Test / methods*
Heart Diseases / epidemiology,  etiology,  prevention & control*
Humans
Middle Aged
Myocardial Ischemia / complications,  radionuclide imaging*
Postoperative Complications / epidemiology,  etiology,  prevention & control*
Predictive Value of Tests
Preoperative Care / methods*
Prospective Studies
Thallium Radioisotopes / diagnostic use*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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