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Previous Volume 330:663-669 March 10, 1994 Number 10 Next

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ABSTRACT

Background Because many patients with atherosclerotic disease of the abdominal aorta also have coronary artery disease, assessment of cardiac risk before abdominal aortic surgery has received much attention. Our prospective study was designed to identify predictors of cardiac risk in consecutive patients evaluated preoperatively with dipyridamole-thallium single-photon-emission computed tomography (SPECT) to assess myocardial perfusion and radionuclide angiography to measure left ventricular ejection fraction.

Methods Clinical and scintigraphic data were collected prospectively during hospitalization in 457 consecutive patients undergoing elective abdominal aortic surgery. Adverse cardiac outcomes were predicted with multivariate analyses.

Results Eighty-six patients (19 percent) had one or more of the following postoperative complications: prolonged myocardial ischemia (61 patients), myocardial infarction (22), congestive heart failure (20), and severe ventricular tachyarrhythmia (2). Twenty patients died postoperatively (4.4 percent), half of them from cardiac causes. Information about myocardial perfusion obtained from dipyridamole-thallium SPECT did not accurately predict adverse cardiac outcomes. The best correlates of cardiac complications were definite clinical evidence of coronary artery disease (odds ratio, 2.6; 95 percent confidence interval, 1.6 to 4.3) and age greater than 65 years (odds ratio, 2.3; 95 percent confidence interval, 1.4 to 3.6). Measurement of the ejection fraction was useful only in the prediction of left ventricular failure. Age greater than 65 years was the only predictor of death (odds ratio, 26.4; 95 percent confidence interval, 3.5 to 200.0).

Conclusions The presence of definite clinical evidence of coronary artery disease and older age were the most important preoperative predictors of an adverse cardiac outcome after abdominal aortic surgery. These results suggest that the routine use of dipyridamole-thallium SPECT and radionuclide angiography for screening before abdominal aortic surgery may not be justified.

Source Information

From the Departments of Anesthesiology (J.-F.B., M.B., E.B., G.G., C.M.S., P.C., P.V.) and Vascular Surgery (E.K.), Hopital Pitie-Salpetriere; the Laboratory of Nuclear Medicine, Hopital Lariboisiere (O.M.); and the Laboratory of Biophysics and INSERM, Unite 141, Hopital Fernand Widal (E.V.) -- all in Paris.

Address reprint requests to Dr. Baron at the Departement d'Anesthesie-Reanimation, Hopital Broussais, 96, rue Didot, 75014 Paris, France.

Full Text of this Article

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Assessment of Cardiac Risk before Abdominal Aortic Surgery
Eagle K. A., Cambria R., Coley C., Abbott W., Baron J.-F.
Extract | Full Text  
N Engl J Med 1994; 331:480, Aug 18, 1994. Correspondence

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