TY - JOUR
T1 - A clinical survival score predicts the likelihood to benefit from preoperative thallium scanning and coronary revascularization before major vascular surgery
AU - Landesberg, Giora
AU - Berlatzky, Yacov
AU - Bocher, Moshe
AU - Alcalai, Ron
AU - Anner, Haim
AU - Ganon-Rozental, Tatyana
AU - Luria, Myron H.
AU - Akopnik, Inna
AU - Weissman, Charles
AU - Mosseri, Morris
PY - 2007/3
Y1 - 2007/3
N2 - Aims: Guidelines advocate selective non-invasive testing before major non-cardiac surgery, yet data defining who may benefit from such tests is lacking. We aimed to find the predictors that define patients who are most likely to benefit from preoperative cardiac testing and coronary revascularization (CR). Methods and results: In 624 consecutive major vascular surgery patients, the preoperative thallium scanning (PTS) results and subsequent CRs were correlated with long-term (3-15 years) survival. Of all patients, 510 (80.6%) had PTS, 154 (24.7%) had moderate-severe ischaemia on PTS, and 96 (15.4%) underwent CR. Seven predictors: age ≥65, diabetes, cerebrovascular disease, ischaemic heart disease, congestive heart failure, ST-depression on preoperative ECG, and renal insufficiency, independently determined long-term survival. A long-term survival score (LTSS) comprised of these predictors, divided all patients into low, intermediate, and high-risk groups (0-1, 2-3, ≥4 predictors, respectively) with a 5-year survival of 83 ± 2%, 60 ± 3%, and 34 ± 6%, respectively. Compared with low-risk patients, intermediate and high-risk patients had worse survival [HR (CI) = 2.6 (2.0-3.4) and 5.9 (4.1-8.9), respectively, P < 0.001]. Yet, only the intermediate-risk group had better long-term survival following preoperative CR [HR = 0.48 (0.31-0.75), P = 0.001]. The low-risk groups' favourable survival and high-risk groups' poor survival were not significantly affected by CR. Conclusion: Intermediate-risk patients (LTSS 2-3) are most likely to have a long-term survival benefit from PTS and CR.
AB - Aims: Guidelines advocate selective non-invasive testing before major non-cardiac surgery, yet data defining who may benefit from such tests is lacking. We aimed to find the predictors that define patients who are most likely to benefit from preoperative cardiac testing and coronary revascularization (CR). Methods and results: In 624 consecutive major vascular surgery patients, the preoperative thallium scanning (PTS) results and subsequent CRs were correlated with long-term (3-15 years) survival. Of all patients, 510 (80.6%) had PTS, 154 (24.7%) had moderate-severe ischaemia on PTS, and 96 (15.4%) underwent CR. Seven predictors: age ≥65, diabetes, cerebrovascular disease, ischaemic heart disease, congestive heart failure, ST-depression on preoperative ECG, and renal insufficiency, independently determined long-term survival. A long-term survival score (LTSS) comprised of these predictors, divided all patients into low, intermediate, and high-risk groups (0-1, 2-3, ≥4 predictors, respectively) with a 5-year survival of 83 ± 2%, 60 ± 3%, and 34 ± 6%, respectively. Compared with low-risk patients, intermediate and high-risk patients had worse survival [HR (CI) = 2.6 (2.0-3.4) and 5.9 (4.1-8.9), respectively, P < 0.001]. Yet, only the intermediate-risk group had better long-term survival following preoperative CR [HR = 0.48 (0.31-0.75), P = 0.001]. The low-risk groups' favourable survival and high-risk groups' poor survival were not significantly affected by CR. Conclusion: Intermediate-risk patients (LTSS 2-3) are most likely to have a long-term survival benefit from PTS and CR.
KW - Coronary revascularization
KW - Long-term survival
KW - Preoperative thallium scanning
KW - Vascular surgery
UR - http://www.scopus.com/inward/record.url?scp=34547568802&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehl390
DO - 10.1093/eurheartj/ehl390
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C2 - 17132653
AN - SCOPUS:34547568802
SN - 0195-668X
VL - 28
SP - 533
EP - 539
JO - European Heart Journal
JF - European Heart Journal
IS - 5
ER -