Document Detail

Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery?
MedLine Citation:
PMID:  12217283     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: 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.
M D Kertai; E Boersma; R Sicari; G J L'Italien; J J Bax; J R T C Roelandt; H van Urk; D Poldermans
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  24     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-09     Completed Date:  2002-09-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  222-9     Citation Subset:  IM    
Departments of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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MeSH Terms
Aorta, Abdominal / surgery*
Cardiotonic Agents / diagnostic use*
Cohort Studies
Dipyridamole / diagnostic use*
Dobutamine / diagnostic use*
Echocardiography, Stress*
Heart / physiopathology,  radionuclide imaging*
Inguinal Canal / surgery*
Outcome Assessment (Health Care)
Perioperative Care*
Phosphodiesterase Inhibitors / diagnostic use*
Postoperative Complications*
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Vascular Surgical Procedures / adverse effects*
Reg. No./Substance:
0/Cardiotonic Agents; 0/Phosphodiesterase Inhibitors; 34368-04-2/Dobutamine; 58-32-2/Dipyridamole

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