Original Article
Dipyridamole-Thallium Scintigraphy and Gated Radionuclide Angiography to Assess Cardiac Risk before Abdominal Aortic Surgery
N Engl J Med 1994; 330:663-669March 10, 1994
- 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.
Media in This Article
Table 1
Preoperative Cardiac Evaluation and Treatments, and Scintigraphic Data for the Study Population and Subgroups of Patients.Table 2
Surgical and Anesthetic Treatment of the Study Population and Subgroups of Patients.Article Activity
- Article
Coronary artery disease is commonly associated with peripheral vascular disease and is a leading cause of morbidity and mortality after vascular surgery1-4. For the preoperative assessment of cardiac risk, several tests have been proposed, including exercise stress testing,5 Holter monitoring,6-8 measurement of the left ventricular ejection fraction,9,10 and dipyridamole-thallium scintigraphy11-15. Scintigraphy permits the assessment of myocardial perfusion in patients who are unable to perform an exercise test. The accuracy of preoperative dipyridamole-thallium scintigraphy in predicting the postoperative risk of myocardial infarction has been emphasized by several studies11-15. However, most previous studies did not enroll consecutive patients, and the physicians caring for the patients were not kept unaware of the scintigraphic data. A recent study overcame these limitations, and it did not confirm the value of dipyridamole-thallium scintigraphy in predicting cardiac outcome16. Since that study was performed, single-photon-emission computed tomography (SPECT) has been developed, with the expectation that it would improve the predictive accuracy of dipyridamole-thallium scintigraphy.
Given the controversy over dipyridamole-thallium scintigraphy, our prospective study was designed to determine the predictors of cardiac risk before elective abdominal aortic surgery. We were particularly interested in evaluating the usefulness of dipyridamole-thallium SPECT (to assess myocardial perfusion) and radionuclide angiography (to measure left ventricular ejection fraction) in the prediction of postoperative cardiac complications.
Methods
Patients
Over a three-year period, 513 patients referred to the Department of Vascular Surgery of the Hopital Pitie-Salpetriere for elective abdominal aortic reconstructive surgery were prospectively included in the study. Informed consent was obtained, and the protocol was approved by the local ethics committee.
Every patient was seen by a staff anesthesiologist, who performed a clinical examination. Previous myocardial infarction was diagnosed on the basis of the patient's history or from electrocardiographic evidence of myocardial infarction. Angina was defined as chest pain with at least three of the following characteristics: substernal location, precipitation by stress, duration of less than 15 minutes, and resolution after rest or nitroglycerin. We paid special attention to identifying ischemic ST-T abnormalities on the preoperative electrocardiogram recorded while the patient was at rest. We explicitly excluded nonspecific ST-T abnormalities. Definite coronary artery disease was indicated by a history of myocardial infarction or angina or by ischemic ST-T abnormalities on the electrocardiogram.
Owing to scheduling problems and technical failures, neither dipyridamole-thallium SPECT nor radionuclide angiography was performed in 45 patients, who were therefore excluded from the study. Indications for coronary angiography were based on clinical findings: new or medically unstable angina, disabling angina, recent myocardial infarction, or persistent angina with a previous myocardial infarction. Thirty-seven patients underwent coronary angiography, which revealed clinically important lesions in 32. In 11 patients, coronary artery disease was considered to be severe and correctable. Percutaneous transluminal coronary angioplasty was performed in five patients, and coronary artery bypass grafting in six. These 11 patients were also excluded from the study, leaving a total of 457 patients in the final analysis.
Dipyridamole-Thallium SPECT
Dipyridamole-thallium SPECT17 was performed 1 to 10 days before surgery. With the patient in the supine position while the electrocardiogram and blood pressure were monitored, dipyridamole was infused intravenously at a rate of 0.14 mg per kilogram of body weight per minute for four minutes. Three minutes after the infusion, 2.5 mCi of intravenous thallium-201 was injected. The initial images were recorded five minutes after the injection, and the delayed images three hours later. Myocardial uptake of thallium was assessed in 32 projections with a 180-degree tomographic acquisition gamma camera (Gammatome II, Sopha Medical, Buc, France). Background noise was automatically subtracted, and the images were filtered with a Butterworth 6/16 filter (Sopha Medical). Sagittal, coronal, and transverse sections were obtained after reconstruction by backward projection, with approximately 10 sections on each axis. The images were interpreted qualitatively by two independent observers. Each section was interpreted with a semiquantitative scoring system using three grades: grade 2 denoted normal uptake; grade 1, moderately decreased uptake; and grade 0, uptake reduced to the background level. Initial thallium scans showing moderate or total perfusion defects (grades 1 and 0, respectively) on two consecutive sections and two different projections were considered abnormal. From the three-dimensional cross sections, thallium abnormalities were classified according to a topographic system with eight areas. Perfusion defects were further categorized as showing redistribution if the defect appeared filled on the delayed images (i.e., if there was improvement by one grade or more) or as being persistent if they did not fill in. Differences in interpretation between observers were resolved by consensus. The two physicians involved in the interpretation were unaware of any preoperative and postoperative clinical information regarding the patients.
Gated Radionuclide Angiography
Radionuclide angiography was performed to measure left ventricular ejection fraction18. After a bolus injection of red cells labeled in vitro, data were collected with a large-field camera when the labeled cells were uniformly distributed in the circulation. Approximately 250 cardiac cycles were recorded with a temporal resolution obtained by gating the registered activity from the electrocardiogram. The cardiac cycles were cumulated to obtain a composite cycle in 12 frames. The end-systolic and end-diastolic frames were selected, and the left ventricular edges outlined. The ejection fraction was derived from end-diastolic and end-systolic counts by a standard formula. The measurements were repeated twice by two experienced physicians, and the mean results were used in our analysis.
Anesthetic and Postoperative Management
The research data were collected in parallel with the clinical data. The physicians caring for the patients had access to the research data and were aware of the clinical findings, the results of dipyridamole-thallium scanning, and any preoperative cardiac evaluation. Preoperative cardiac treatment was continued until two hours before surgery (Table 1Table 1
Preoperative Cardiac Evaluation and Treatments, and Scintigraphic Data for the Study Population and Subgroups of Patients.). ST-T segments were continuously monitored (with leads DII, CS5, and V4) (Marquette 7010 Monitor, Milwaukee) in only 323 patients during the preoperative and intraoperative period, depending on the availability of the monitor. Standard electrocardiographic monitoring was used for the remaining patients. The unblinding of the data did not induce a selection bias, since no major difference in the use of ST-segment analysis was observed in relation to clinical symptoms or scintigraphic findings (Table 2Table 2Surgical and Anesthetic Treatment of the Study Population and Subgroups of Patients.). In all 457 patients, hemodynamic measures obtained from radial-artery and pulmonary-artery catheters were continuously monitored perioperatively.The anesthetic techniques used were either balanced general anesthesia (in 275 patients) or thoracic epidural anesthesia associated with light general anesthesia (in 182 patients) as described elsewhere19. The use of postoperative analgesia was not dictated by the study protocol. Three analgesic techniques were used: subcutaneous morphine (in 178 patients), epidural bupivacaine (218 patients), and epidural fentanyl (61 patients). After the operation, the patients were continuously monitored for at least 24 hours in an intensive care unit. Electrocardiographic recordings (with 12 leads) were repeated during the immediate postoperative period and daily during the first 10 postoperative days. Chest films were also repeated daily, at least during the first six postoperative days. Cardiac enzymes were measured each day postoperatively until the 10th postoperative day. Serum creatine kinase MB isoenzyme was assessed with a chemiluminescence immunoassay20.
Surgical Management
All patients underwent inclusion graft procedures involving the abdominal aorta. Suprarenal aortic cross-clamping was required in 74 patients. The prosthetic graft was a straight tube in 94 patients and a bifurcated graft in 363 patients. Associated vascular procedures are described in Table 2. The mean (±SD) duration of the surgical procedure was 3.8 ±1.6 hours.
Analysis of Clinical Outcomes
The major clinical outcome variables prospectively analyzed were mortality and major cardiac morbidity. Adverse outcomes were reported by the physicians caring for the patients and were validated separately by two investigators. Disagreements were resolved by consensus.
Mortality was defined as death occurring within 30 days after the surgical procedure. A postoperative cardiac complication was defined as the appearance of prolonged myocardial ischemia, myocardial infarction, congestive heart failure, or ventricular tachyarrhythmias. Prolonged myocardial ischemia was defined as a new ST-T abnormality (ST depression >1 mm at 60 msec after the J point) on at least two successive daily 12-lead electrocardiograms. We also considered patients with persistent T-wave inversion after an episode of ST-segment depression as having prolonged myocardial ischemia.
The diagnosis of postoperative myocardial infarction required diagnosis at autopsy, new Q waves on the electrocardiogram that were at least 0.04 second in duration and 1 mm in depth, or persistent ST-segment depression associated with an elevation of the serum creatine kinase MB isoenzyme (to >20 ng per milliliter). Congestive heart failure was defined as the need for sympathomimetic support (dobutamine or dopamine) during the postoperative period associated with hemodynamic and pulmonary findings consistent with the diagnosis: classic chest-film changes, pulmonary-capillary wedge pressure persistently greater than 18 mm Hg, or both. An impairment in global left ventricular function was assessed by transesophageal echocardiography as standard clinical practice to clarify all postoperative hemodynamic disorders. Ventricular tachyarrhythmia was defined as a documented ventricular tachycardia or fibrillation with hemodynamic compromise.
Statistical Analysis
Potential univariate correlates of adverse cardiac outcomes were identified by chi-square analysis or Fisher's exact test. Multivariate analysis was performed with stepwise logistic regression (Biomedical Data Processing Package, UCLA, Los Angeles). To avoid overestimating the number of predictive variables,21,22 we selected these variables with conservative criteria, as follows: limits to enter or remove variables in the regression equation must have had a 5 percent probability value; the ratio between the corresponding regression coefficient and its standard error must have been greater than 223; and results were verified by two numerical procedures, an asymptotic covariance estimate and the maximum-likelihood method. Univariate and multivariate odds ratios and their 95 percent confidence intervals were calculated from the model.
In addition, for the best estimate of the predictive powers of dipyridamole-thallium SPECT and radionuclide angiography, a complementary multivariate procedure was carried out. Fixed-defect scans, scans showing redistribution, and those with an ejection fraction of less than 50 percent were forced into the multivariate model, and adjusted odds ratios were recalculated from the resulting models.
Results
Characteristics of the Patients
A total of 468 patients (mean [±SD] age, 63 ±11 years) were initially enrolled in the study (11 patients with severe but correctable coronary artery disease were subsequently excluded). Of these, 202 were more than 65 years old. Definite coronary artery disease was observed in 163 patients (Table 1). Thallium defects were observed in 254 patients and were categorized as persistent in 94 and as showing redistribution in 160. The relation between clinical findings and data obtained by dipyridamole-thallium SPECT is shown in Table 1. The ejection fraction was below 50 percent in 75 patients and below 35 percent in 7. Intraoperative anesthetic and surgical management was not influenced by preoperative unblinded cardiac assessment with dipyridamole-thallium SPECT and radionuclide angiography (Table 2).
Clinical Outcomes
Eighty-six patients (19 percent) had at least one postoperative complication: prolonged myocardial ischemia (61 patients), myocardial infarction (22), congestive heart failure (20), or severe ventricular tachyarrhythmia (2). Twenty patients (4.4 percent) died postoperatively, five of myocardial infarction and five of left ventricular failure. Multiple-organ failure was the cause of death in the remaining 10 patients.
Univariate Analysis
The preoperative variables significantly associated with an adverse cardiac outcome in the univariate analysis (Table 3Table 3
Univariate and Multivariate Analysis of 86 Patients with Cardiac Complications.) were an age greater than 65 years, previous myocardial infarction, a history of angina, ischemic ST-T abnormalities, definite coronary artery disease, hypertension, and an ejection fraction of less than 50 percent. The variables obtained from dipyridamole-thallium SPECT -- a scan with a fixed defect, or one showing thallium redistribution -- were not univariate correlates of adverse cardiac outcomes. Univariate analyses of each cardiac complication and of postoperative mortality are shown in Table 3, Table 4Table 4
Univariate and Multivariate Analysis of Postoperative Myocardial Infarction, Prolonged Myocardial Ischemia, and Left Ventricular Failure., and Table 5Table 5
Univariate and Multivariate Analysis of 20 Postoperative Deaths..Multivariate Analysis
The preoperative predictors of cardiac complications were definite coronary artery disease and age greater than 65 years (Table 3). In patients 65 or younger who did not have definite coronary artery disease (169 patients, or 37 percent), the rate of cardiac complications was 10 percent. In patients with one of the two predictors (288 patients, or 63 percent), the cardiaccomplication rate was 24 percent. In patients with both predictors (77 patients, or 17 percent), the cardiac-complication rate was 39 percent. Definite coronary artery disease was the only characteristic in the multivariate analysis that was associated with the occurrence of prolonged myocardial ischemia (Table 4). The preoperative predictors of postoperative myocardial infarction were definite coronary artery disease and age greater than 65 years (Table 4). Age greater than 65 years, previous myocardial infarction, and an ejection fraction below 50 percent were the predictors of postoperative congestive left ventricular failure (Table 4). Age greater than 65 years was the only characteristic associated with postoperative mortality in the multivariate analysis (Table 5).
The values of adjusted odds ratios when these variables were inserted into the model to obtain the best estimate demonstrate the weak predictive power of thallium scintigraphic data and ejection fraction (Table 3, Table 4, and Table 5).
Discussion
The principal finding of this study is that definite clinical evidence of coronary artery disease and age are the two most important variables correlated with adverse cardiac outcomes in patients undergoing abdominal aortic surgery. In contrast, the results of dipyridamole-thallium SPECT were not predictive of adverse cardiac outcomes.
The preoperative clinical characteristics and rates of cardiac complications in our patients were very similar to those in previous reports11-15,24. Patients with severe and correctable coronary artery disease were excluded from the analysis. However, indications for coronary angiography were based on predefined clinical criteria and did not take scintigraphic data into account. A total of 37 patients underwent coronary angiography, and 11 patients had myocardial revascularization procedures. The inclusion of these 11 patients did not influence the results of the statistical analysis.
Another issue is that unblinded preoperative cardiac evaluation could have influenced anesthetic management. Pulmonary-artery catheters were inserted in all patients, and intraoperative ST-T analysis was performed in most. The type of anesthetic technique used, either balanced general anesthesia or thoracic epidural anesthesia associated with light general anesthesia, was not dictated by the protocol. We recently showed in a large randomized study that these two techniques have similar influences on postoperative outcome19. High-dose narcotic anesthesia, which is frequently used elsewhere in patients with severe coronary artery disease or ventricular dysfunction, was not used in this study. The analgesic technique was not chosen according to the results of the preoperative cardiac evaluation. Although postoperative care was identical in all patients with regard to other treatments, we cannot rule out the possibility that the analgesic techniques could themselves have influenced the postoperative outcome.
The incidence of postoperative unstable angina could have been underestimated in our study. Since the diagnosis of prolonged myocardial ischemia was based only on the persistence of new ST-T abnormalities on at least two successive daily electrocardiograms, we cannot rule out the possibility that shorter episodes of unstable angina may have occurred. The incidence of ventricular dysrhythmias may also have been underestimated because of the absence of a continuous recording technique24.
Many studies have identified preoperative clinical markers that correlate with postoperative adverse cardiac outcomes. A history of myocardial infarction,25-27 angina pectoris,26 abnormal base-line electrocardiography,25-28 advanced age,28 hypertension,28 diabetes mellitus,28 congestive heart failure,25,28 and cardiac arrhythmias25,27 are the most frequently reported markers. Several clinical scoring systems27,29-31 have been identified with multivariate discriminant analysis. Although this point was not investigated in this study, it has recently been stressed that intraoperative and postoperative variables could be major predictors of postoperative adverse cardiac outcomes. In the study by Mangano et al.,24 postoperative ischemia was a more powerful correlate. In a study of 254 patients scheduled for vascular surgery, Eagle and coworkers15 used multivariate analysis to identify five clinical factors that were independent correlates of postoperative cardiac events. These markers were advanced age (>70 years), Q waves on the electrocardiogram, diabetes mellitus, a history of ventricular arrhythmias, and a history of angina. Except for diabetes mellitus, these clinical markers are very similar to those we identified. The higher prevalence of diabetes mellitus in the study by Eagle et al. -- 18 percent, as compared with 8.5 percent in our study -- is probably responsible for the difference. Their inclusion of one third of patients with peripheral vascular surgery (femoropopliteal bypass) could explain the higher prevalence of diabetes mellitus in their study.
Several studies have suggested that dipyridamole-thallium scintigraphy is the ideal preoperative screening test for evaluating the risk of postoperative myocardial infarction11-15. Thallium redistribution has been shown to be the most important predictor. In comparison, we enrolled more patients and did not confirm the ability of thallium scanning to predict the risk of cardiac complications. These results support those of Mangano et al.,16 who reported in a recent prospective study of 60 patients undergoing vascular procedures that there was no association between redistribution defects and adverse cardiac outcomes. Some aspects of this controversy have been discussed by Mangano et al. Most previous studies did not enroll consecutive patients. Another issue is the nonstandardization of monitoring and of the use of anesthetic and surgical techniques, mainly because physicians were not blinded to the scintigraphic data. Although Mangano et al. overcame these limitations, they studied a limited number of patients and used planar dipyridamole-thallium scintigraphy, not SPECT. Some technical aspects of planar dipyridamole-thallium scintigraphy and its reliability in detecting coronary artery disease have already been questioned32-34. Better identification of artifactual defects can be expected with SPECT, although it does not perfectly distinguish fixed defects from those with redistribution35. These limitations are likely to explain the weak relation observed between clinical findings and dipyridamole-thallium scans and may partly explain the lack of prediction of cardiac outcome.
Several studies have demonstrated a higher risk of postoperative morbidity and mortality in patients with impaired preoperative left ventricular function9,36,37. Kazmers et al.37,38 reported conflicting results with regard to postoperative mortality. In our study, left ventricular ejection fraction as assessed by radionuclide angiography was a significant predictor only of postoperative left ventricular failure.
Conclusions
As compared with most recent studies, our study does not confirm that dipyridamole-thallium SPECT is an accurate screening test for the evaluation of cardiac risk before abdominal aortic surgery. The value of measuring the ejection fraction is limited to the prediction of postoperative left ventricular failure. Definite clinical evidence of coronary artery disease and age greater than 65 years are the most important preoperative predictors of adverse cardiac outcomes. On the basis of these data, we question whether the substantial cost of preoperative assessment with dipyridamole-thallium scintigraphy and radionuclide angiography is warranted.
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.
- References
References
1
Thompson JE ,Hollier LH ,Patman RD ,Persson AV . Surgical management of abdominal aortic aneurysms: factors influencing mortality and morbidity -- a 20-year experience. Ann Surg 1975;181:654-661
CrossRef | Web of Science | Medline2
Gouny P ,Bertrand M ,Coriat P ,Kieffer E . Perioperative cardiac complications of surgical repair of infrarenal aortic aneurysms. Ann Vasc Surg 1989;3:328-334
CrossRef | Medline3
Crawford ES ,Bomberger RA ,Glaeser DH ,Saleh SA ,Russell WL . Aortoiliac occlusive disease: factors influencing survival and function following reconstructive operation over a twenty-five-year period. Surgery 1981;90:1055-1067
Web of Science | Medline4
Hertzer NR ,Beven EG ,Young JR , et al. Coronary artery disease in peripheral vascular patients: a classification of 1000 coronary angiograms and results of surgical management. Ann Surg 1984;199:223-233
CrossRef | Web of Science | Medline5
Carliner NH ,Fisher ML ,Plotnick GD , et al. Routine preoperative exercise testing in patients undergoing major noncardiac surgery. Am J Cardiol 1985;56:51-58
CrossRef | Web of Science | Medline6
Raby KE ,Goldman L ,Creager MA , et al. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989;321:1296-1300
Full Text | Web of Science | Medline7
Hollenberg M ,Mangano DT ,Browner WS ,London MJ ,Tubau JF ,Tateo IM . Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery: the Study of Perioperative Ischemia Research Group. JAMA 1992;268:205-209
CrossRef | Web of Science | Medline8
Raby KE ,Barry J ,Creager MA ,Cook EF ,Weisberg MC ,Goldman L . Detection and significance of intraoperative and postoperative myocardial ischemia in peripheral vascular surgery. JAMA 1992;268:222-227
CrossRef | Web of Science | Medline9
Acinapura AJ ,Rose DM ,Kramer MD ,Jacobowitz IJ ,Cunningham JN Jr . Role of coronary angiography and coronary artery bypass surgery prior to abdominal aortic aneurysmectomy. J Cardiovasc Surg (Torino) 1987;28:552-557
Web of Science | Medline10
Pasternack PF ,Imparato AM ,Bear G , et al. The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection. J Vasc Surg 1984;1:320-325
CrossRef | Web of Science | Medline11
Boucher CA ,Brewster DC ,Darling RC ,Okada RD ,Strauss HW ,Pohost GM . Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med 1985;312:389-394
Full Text | Web of Science | Medline12
Leppo J ,Plaja J ,Gionet M ,Tumolo J ,Paraskos JA ,Cutler BS . Noninvasive evaluation of cardiac risk before elective vascular surgery. J Am Coll Cardiol 1987;9:269-276
CrossRef | Web of Science | Medline13
Cutler BS ,Leppo JA . Dipyridamole thallium 201 scintigraphy to detect coronary artery disease before abdominal aortic surgery. J Vasc Surg 1987;5:91-100
CrossRef | Web of Science | Medline14
Eagle KA ,Singer DE ,Brewster DC ,Darling RC ,Mulley AG ,Boucher CA . Dipyridamole-thallium scanning in patients undergoing vascular surgery: optimizing preoperative evaluation of cardiac risk. JAMA 1987;257:2185-2189
CrossRef | Web of Science | Medline15
Eagle KA ,Coley CM ,Newell JB , et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989;110:859-866
Web of Science | Medline16
Mangano DT ,London MJ ,Tubau JF , et al. Dipyridamole thallium-201 scintigraphy as a preoperative screening test: a reexamination of its predictive potential. Circulation 1991;84:493-502
Web of Science | Medline17
Eisner RL ,Nowak DJ ,Pettigrew R ,Fajman W . Fundamentals of 180 degrees acquisition and reconstruction in SPECT imaging. J Nucl Med 1986;27:1717-1728
Web of Science | Medline18
Marshall RC ,Berger HJ ,Costin JC , et al. Assessment of cardiac performance with quantitative radionuclide angiocardiography: sequential left ventricular ejection fraction, normalized left ventricular ejection rate, and regional wall motion. Circulation 1977;56:820-829
Web of Science | Medline19
Baron JF ,Bertrand M ,Barre E , et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiology 1991;75:611-618
CrossRef | Web of Science | Medline20
Bernard MA ,Brochet C ,Adam Y , et al. Critical evaluation of chemiluminescence immunoassay of creatine kinase isoenzyme MB. Clin Chem Enzymol Commun 1989;2:35-4221
Dixon WJ, ed. BMDP statistical software. Berkeley: University of California Press, 1985.
22
Draper NH, Smith H. Regression analysis. New York: John Wiley, 1967.
23
Mantel N ,Haenszel W . Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719-748
Web of Science | Medline24
Mangano DT ,Browner WS ,Hollenberg M , et al. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 1990;323:1781-1788
Full Text | Web of Science | Medline25
Cooperman M ,Pflug B ,Martin EW Jr ,Evans WE . Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 1978;84:505-509
Web of Science | Medline26
Jamieson WRE ,Janusz MT ,Miyagishima RT ,Gerein AN . Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease. Circulation 1982;66:Suppl I:I-9227
Detsky AS ,Abrams HB ,McLaughlin JR , et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986;1:211-219
CrossRef | Web of Science | Medline28
DeBakey ME ,Lawrie GM . Combined coronary artery and peripheral vascular disease: recognition and treatment. J Vasc Surg 1984;1:605-607
CrossRef | Web of Science | Medline29
Dripps RD ,Lamont A ,Eckenhoff JE . The role of anesthesia in surgical mortality. JAMA 1961;178:261-266
Web of Science | Medline30
Goldman L ,Caldera DL ,Nussbaum SR , et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977;297:845-850
Full Text | Web of Science | Medline31
Cooperman M ,Pflug B ,Martin EW Jr ,Evans WE . Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 1978;84:505-509
Web of Science | Medline32
Gould KL . Quantitative imaging in nuclear cardiology. Circulation 1982;66:1141-1146
CrossRef | Web of Science | Medline33
Leppo J ,Yipintsoi T ,Blankstein R , et al. Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests. Circulation 1979;59:714-721
Web of Science | Medline34
Leppo J ,Boucher CA ,Okada RD ,Newell JB ,Strauss HW ,Pohost GM . Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion. Circulation 1982;66:649-657
CrossRef | Web of Science | Medline35
Dilsizian V ,Rocco TP ,Freedman NMT ,Leon MB ,Bonow RO . Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med 1990;323:141-146
Full Text | Web of Science | Medline36
Fiser WP ,Thompson BW ,Thompson AR ,Eason C ,Read RC . Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery. Surgery 1983;94:736-739
Web of Science | Medline37
Kazmers A ,Cerqueira MD ,Zierler RE . Perioperative and late outcome in patients with left ventricular ejection fraction of 35% or less who require major vascular surgery. J Vasc Surg 1988;8:307-315
CrossRef | Web of Science | Medline38
Kazmers A ,Cerqueira MD ,Zierler RE . The role of preoperative radionuclide ejection fraction in direct abdominal aortic aneurysm repair. J Vasc Surg 1988;8:128-136
CrossRef | Web of Science | Medline
- Citing Articles (92)
Citing Articles
1
Angela S. Koh, Jennifer L. S. Flores, Felix Y. J. Keng, Ru San Tan, Terrance S. J. Chua. (2012) Correlation between clinical outcomes and appropriateness grading for referral to myocardial perfusion imaging for preoperative evaluation prior to non-cardiac surgery. Journal of Nuclear Cardiology
CrossRef2
M. West, S. Jack, M.P.W. Grocott. (2011) Perioperative cardiopulmonary exercise testing in the elderly. Best Practice & Research Clinical Anaesthesiology 25:3, 427-437
CrossRef3
Nicola Troisi, Walter Dorigo, Patrizia Lo Sapio, Giovanni Pratesi, Raffaele Pulli, Gian Franco Gensini, Carlo Pratesi. (2010) Bilan cardiaque préopératoire des patients pour chirurgie aortique : analyse des facteurs influençant les suites cardiaques. Annales de Chirurgie Vasculaire 24:6, 800-807
CrossRef4
Nicola Troisi, Walter Dorigo, Patrizia Lo Sapio, Giovanni Pratesi, Raffaele Pulli, Gian Franco Gensini, Carlo Pratesi. (2010) Preoperative Cardiac Assessment in Patients Undergoing Aortic Surgery: Analysis of Factors Affecting the Cardiac Outcomes. Annals of Vascular Surgery 24:6, 733-740
CrossRef5
Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliot L. Chaikof, Kirsten E. Fleischmann, William K. Freeman, James B. Froehlich, Edward K. Kasper, Judy R. Kersten, Barbara Riegel, John F. Robb. (2009) 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Journal of the American College of Cardiology 54:22, e13-e118
CrossRef6
Freddie M. Williams, James D. Bergin. (2009) Cardiac Screening Before Noncardiac Surgery. Surgical Clinics of North America 89:4, 747-762
CrossRef7
Daiki Kayano, Kenichi Nakajima, Hiroshi Ohtake, Seigo Kinuya. (2009) Gated myocardial perfusion SPECT for preoperative risk stratification in patients with noncardiac vascular disease. Annals of Nuclear Medicine 23:2, 173-181
CrossRef8
Matthias Jacob, Daniel Chappell, Markus W Hollmann. (2009) Current aspects of perioperative fluid handling in vascular surgery. Current Opinion in Anaesthesiology 22:1, 100-108
CrossRef9
Christian de Virgilio, Arezou Yaghoubian, Alex Nguyen, Roger J. Lewis, Christine Dauphine, Grant Sarkisyan, Darrell W. Harrington. (2009) Peripheral Vascular Surgery Using Targeted Beta Blockade Reduces Perioperative Cardiac Event Rate. Journal of the American College of Surgeons 208:1, 14-20
CrossRef10
Feroze Mahmood, Robina Matyal, Andrew Maslow, Balachundar Subramaniam, John Mitchell, Peter Panzica, Swaminathan Karthik, Philip Hess. (2008) Myocardial Performance Index Is a Predictor of Outcome After Abdominal Aortic Aneurysm Repair. Journal of Cardiothoracic and Vascular Anesthesia 22:5, 706-712
CrossRef11
Joshua A. Beckman, Mark A. Creager. 2008. Perioperative Management of Vascular Surgery. , 115-123.
CrossRef12
Colleen Christmas, Roy C. Ziegelstein, Lee A. Fleisher. 2008. Perioperative Cardiovascular Evaluation and Treatment of Elderly Patients Undergoing Noncardiac Surgery. , 769-810.
CrossRef13
Ronit Lavi, Shahar Lavi, Elena Daghini, Lilach O. Lerman. (2007) New Frontiers in the Evaluation of Cardiac Patients for Noncardiac Surgery. Anesthesiology 107:6, 1018-1028
CrossRef14
Lee A. Fleisher, Joshua A. Beckman, Kenneth A. Brown, Hugh Calkins, Elliott L. Chaikof, Kirsten E. Fleischmann, William K. Freeman, James B. Froehlich, Edward K. Kasper, Judy R. Kersten, Barbara Riegel, John F. Robb, Sidney C. Smith, Alice K. Jacobs, Cynthia D. Adams, Jeffrey L. Anderson, Elliott M. Antman, Christopher E. Buller, Mark A. Creager, Steven M. Ettinger, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Sharon A. Hunt, Bruce W. Lytle, Rick Nishimura, Joseph P. Ornato, Richard L. Page, Barbara Riegel, Lynn G. Tarkington, Clyde W. Yancy. (2007) ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. Journal of the American College of Cardiology 50:17, e159-e242
CrossRef15
R. Parker Ward, Sascha N. Goonewardena, Georgeanne Lammertin, Roberto M. Lang. (2007) Comparison of the Frequency of Abnormal Cardiac Findings by Echocardiography in Patients With and Without Peripheral Arterial Disease. The American Journal of Cardiology 99:4, 499-503
CrossRef16
F. Kerbaul, C. Guidon. (2007) Anestesia del paziente coronaropatico in chirurgia generale. EMC - Anestesia-Rianimazione 12:3, 1-18
CrossRef17
Jun Hashimoto, Tadaki Nakahara, Jingming Bai, Naoto Kitamura, Tomotaka Kasamatsu, Atsushi Kubo. (2007) Preoperative Risk Stratification With Myocardial Perfusion Imaging in Intermediate and Low-Risk Non-Cardiac Surgery. Circulation Journal 71:9, 1395-1400
CrossRef18
Hovig V Chitilian, Eric M Isselbacher, Michael G Fitzsimons. (2006) Preoperative Cardiac Evaluation for Vascular Surgery. International Anesthesiology Clinics 43:1, 1-14
CrossRef19
Nader N. Boushra, Muhammad Muntazar. (2006) Review article: The role of statins in reducing perioperative cardiac risk: physiologic and clinical perspectives. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 53:11, 1126-1147
CrossRef20
Pietro Amedeo Modesti, Ignazio Simonetti, Giuseppe Olivo. (2006) Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications. Internal and Emergency Medicine 1:3, 177-186
CrossRef21
Ramesh Venkataraman. (2006) Vascular surgery critical care: Perioperative cardiac optimization to improve survival. Critical Care Medicine 34:Suppl, S200-S207
CrossRef22
J. T. Lee, E. J. Chaloner, S. J. Hollingsworth. (2006) The role of cardiopulmonary fitness and its genetic influences on surgical outcomes. British Journal of Surgery 93:2, 147-157
CrossRef23
Xiangru Lu, Joel A. Hamilton, Ji Shen, Theresa Pang, Douglas L. Jones, Richard F. Potter, J Malcolm O. Arnold, Qingping Feng. (2006) Role of tumor necrosis factor-?? in myocardial dysfunction and apoptosis during hindlimb ischemia and reperfusion. Critical Care Medicine 34:2, 484-491
CrossRef24
W Scott Beattie, Esam Abdelnaem, Duminda N. Wijeysundera, D Norman Buckley. (2006) A Meta-Analytic Comparison of Preoperative Stress Echocardiography and Nuclear Scintigraphy Imaging. Anesthesia & Analgesia 102:1, 8-16
CrossRef25
Norman R. Hertzer, Edward J. Mascha. (2005) A personal experience with factors influencing survival after elective open repair of infrarenal aortic aneurysms. Journal of Vascular Surgery 42:5, 898.e1-898.e10
CrossRef26
Yannick Le Manach, Azriel Perel, Pierre Coriat, Gilles Godet, Mich??le Bertrand, Bruno Riou. (2005) Early and Delayed Myocardial Infarction after Abdominal Aortic Surgery. Anesthesiology 102:5, 885-891
CrossRef27
Jaafer A. Golzar, Assad Movahed. (2005) Value of absence of a transient myocardial perfusion defect during stress myocardial perfusion study in patients undergoing major vascular surgery. The International Journal of Cardiovascular Imaging 21:2-3, 267-270
CrossRef28
S. Eschertzhuber, M. Hohlrieder, C. Boesmueller, A. Pomaroli, W. Steurer, T. Junker, R. Margreiter, C. Hoermann. (2005) Incidence of Coronary Heart Disease and Cardiac Events in Patients Undergoing Kidney and Pancreatic Transplantation. Transplantation Proceedings 37:2, 1297-1300
CrossRef29
Katsufumi Harafuji, Taishiro Chikamori, Satoshi Kawaguchi, Yukio Obitsu, Shigeki Ito, Yuko Igarashi, Hirokazu Tanaka, Yasuhiro Usui, Satoshi Hida, Shin Ishimaru, Akira Yamashina. (2005) Value of Pharmacologic Stress Myocardial Perfusion Imaging for Preoperative Risk Stratification for Aortic Surgery. Circulation Journal 69:5, 558-563
CrossRef30
William C. Krupski, Robert B. Rutherford. (2004) Update on open repair of abdominal aortic aneurysms: The challenges for endovascular repair. Journal of the American College of Surgeons 199:6, 946-960
CrossRef31
S RINCKENBACH, O HASSANI, F THAVEAU, Y BENSIMON, X JACQUOT, S EDAHTALLY, B GENY, B EISENMANN, A CHARPENTIER, N CHAKFE. (2004) Current Outcome of Elective Open Repair for Infrarenal Abdominal Aortic Aneurysm. Annals of Vascular Surgery 18:6, 704-709
CrossRef32
Giora Landesberg, Morris Mosseri, Vadim Shatz, Inna Akopnik, Moshe Bocher, Michael Mayer, Haim Anner, Yacov Berlatzky, Charles Weissman. (2004) Cardiac Troponin After Major Vascular Surgery. Journal of the American College of Cardiology 44:3, 569-575
CrossRef33
Robert B Rutherford, William C Krupski. (2004) Current status of open versus endovascular stent-graft repair of abdominal aortic aneurysm. Journal of Vascular Surgery 39:5, 1129-1139
CrossRef34
Shamsuddin Akhtar, David G. Silverman. (2004) Assessment and management of patients with ischemic heart disease. Critical Care Medicine 32:Supplement, S126-S136
CrossRef35
Steven L Cohn, Lee Goldman. (2003) Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Medical Clinics of North America 87:1, 111-136
CrossRef36
P.- G. Chassot, A. Delabays, D. R. Spahn. (2002) Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. British Journal of Anaesthesia 89:5, 747-759
CrossRef37
M.D. Kertai, E. Boersma, R. Sicari, G.J. L'Italien, J.J. Bax, J.R.T.C. Roelandt, H. van Urk, D. Poldermans. (2002) Which Stress Test is Superior for Perioperative Cardiac Risk Stratification in Patients Undergoing Major Vascular Surgery?. European Journal of Vascular and Endovascular Surgery 24:3, 222-229
CrossRef38
David Amar, Hao Zhang, Nancy Roistacher. (2002) The Incidence and Outcome of Ventricular Arrhythmias After Noncardiac Thoracic Surgery. Anesthesia & Analgesia 95:3, 537-543
CrossRef39
Tao Chen, Yasuo Kuwabara, Hiroyuki Tsutsui, Masayuki Sasaki, Makoto Nakagawa, Hirofumi Koga, Kouichirou Kaneko, Kimihiro Komori, Kouji Masuda. (2002) The usefulness of dipyridamole thallium-201 single photon emission computed tomography for predicting perioperative cardiac events in patients undergoing non-cardiac vascular surgery. Annals of Nuclear Medicine 16:1, 45-53
CrossRef40
Robert Kelly, Anthony Staines, Ron MacWalter, Peter Stonebridge, Hugh Tunstall-Pedoe, Allan D Struthers. (2002) The prevalence of treatable left ventricular systolic dysfunction in patients who present with noncardiac vascular episodes. Journal of the American College of Cardiology 39:2, 219-224
CrossRef41
N. Mamode, G. Docherty, G.D.O. Lowe, P.W. Macfarlane, W. Martin, J.G. Pollock, S.M. Cobbe. (2001) The Role of Myocardial Perfusion Scanning, Heart Rate Variability and D-dimers in Predicting the Risk of Perioperative Cardiac Complications after Peripheral Vascular Surgery. European Journal of Vascular and Endovascular Surgery 22:6, 499-508
CrossRef42
M. Bertrand, G. Godet, F. Koskas, P. Cluzel, M.-H. Fleron, E. Kieffer, P. Coriat. (2001) Endovascular treatment of abdominal aortic aneurysms: is there a benefit regarding postoperative outcome?. European Journal of Anaesthesiology 18:4, 245-250
CrossRef43
Aman Chugh, Eduardo Bossone, Rajendra H. Mehta. (2001) Cardiac risk assessment for noncardiac surgery: Current concepts. Comprehensive Therapy 27:1, 47-55
CrossRef44
A Roghi, B Palmieri, W Crivellaro, F Faletra, M Puttini. (2001) Relationship of Unrecognised Myocardial Infarction, Diabetes Mellitus and Type of Surgery to Postoperative Cardiac Outcomes in Vascular Surgery. European Journal of Vascular and Endovascular Surgery 21:1, 9-16
CrossRef45
Kyung W. Park. (2001) Tests of Myocardial Function: Echocardiography and Nuclear Medicine Studies. International Anesthesiology Clinics 39:4, 11-19
CrossRef46
Albrecht Gauss, Hans-Jörg Röhm, Andreas Schäuffelen, Thomas Vogel, Ulrich Mohl, Andreas Straehle, Rainer Meierhenrich, Michael Georgieff, Gerald Steinbach, Wolfram Schütz. (2001) Electrocardiographic Exercise Stress Testing for Cardiac Risk Assessment in Patients Undergoing Noncardiac Surgery. Anesthesiology 94:1, 38-46
CrossRef47
S W Zarich, E T Pierce, R W Nesto, M A Mittleman, R H Bode, G Kowalchuk, M C Cohen. (2001) Age and history of cardiac disease as risk factors for cardiac complications after peripheral vascular surgery in diabetic patients.. Mayo Clinic Proceedings 76:1, 34-38
CrossRef48
C. D. KARKOS, J. C. HILL, G. J.L. THOMSON, R. HUGHES, U. S. MUKHOPADHYAY, O. UMUGHELE, C. SELVASEKAR. (2000) Impact of radionuclide ventriculography prior to elective abdominal aortic reconstruction. Nuclear Medicine Communications 21:11, 1021-1027
CrossRef49
G. Godet, M. Dumerat, C. Baillard, S. Ben Ayed, M.-A. Bernard, M. Bertrand, E. Kieffer, P. Coriat. (2000) Cardiac troponin I is reliable with immediate but not medium-term cardiac complications after abdominal aortic repair. Acta Anaesthesiologica Scandinavica 44:5, 592-597
CrossRef50
Emmanuel Samain, Eviane Farah, Guy Lesèche, Jean Marty. (2000) Guidelines for perioperative cardiac evaluation from the American College of Cardiology/American Heart Association task force are effective for stratifying cardiac risk before aortic surgery. Journal of Vascular Surgery 31:5, 971-979
CrossRef51
DON POLDERMANS, JEROEN J. BAX, IAN R. THOMSON, ERIC BOERSMA, PETER VAN DER MEER, PAOLO M. FIORETTI, ABDOU ELHENDY, LOUIS M.M. VAN DE VEN, JOS R.T.C. ROELANDT, HERO VAN URK. (2000) Role of Dobutamine Stress Echocardiography for Preoperative Cardiac Risk Assessment Before Major Vascular Surgery: A Diagnostic Tool Comes of Age. Echocardiography 17:1, 79-91
CrossRef52
M Fusari. (2000) Coronary and major vascular disease: aggressive screening and priority-based therapy. Cardiovascular Surgery 8:1, 22-30
CrossRef53
Thomas H. Marwick, Peter Cain. (1999) SCREENING FOR CORONARY ARTERY DISEASE. Medical Clinics of North America 83:6, 1375-1402
CrossRef54
Elisabetta Rossi, Franco Citterio. (1999) Cardiac risk stratification of patients undergoing vascular surgery. Comprehensive Therapy 25:11-12, 461-466
CrossRef55
STEVEN C. SMART, KIRAN B. SAGAR. (1999) Diagnostic and Prognostic Use of Stress Echocardiography and Radionuclide Scintigraphy. Echocardiography 16:8, 857-877
CrossRef56
Dennis T. Mangano. (1999) Assessment of the Patient with Cardiac Disease. Anesthesiology 91:5, 1521
CrossRef57
M Batt, P Staccini, P Pittaluga, E Ferrari, R Hassen-Khodja, S Declemy. (1999) Late Survival After Abdominal Aortic Aneurysm Repair. European Journal of Vascular and Endovascular Surgery 17:4, 338-342
CrossRef58
Pierre Couture, Daniel Boudreault. (1998) Epidural Analgesia and Intravenous Patient-Controlled Analgesia Result in Similar Rates of Myocardial Ischemia After Aortic Surgery. Anesthesia & Analgesia 87:3, 745-746
CrossRef59
Michel Dahan, Béatrice M Viron, Marc Faraggi, Dominique L Himbert, Bruno J J Legallicier, Amir M Kolta, Fabienne Pessione, Dominique Le Guludec, R Gourgon, Françoise E Mignon. (1998) Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney International 54:1, 255-262
CrossRef60
Pierre Coriat. (1998) Reducing cardiovascular risk in patients undergoing non-cardiac surgery. Current Opinion in Anaesthesiology 11:3, 311-314
CrossRef61
Michel Batt, Emile Ferrari, Pascal Staccini, Reda Hassen-Khodja, Serge Declemy, Philippe Morand, Pierre Bas. (1998) Severity of tibio peroneal arterial disease: A marker for coronary artery disease. International Journal of Angiology 7:2, 97-101
CrossRef62
Ziyang Huang, Sadayoshi Komori, Takao Sawanobori, Isao Kohno, Souichi Sano, Tsukasa lshihara, Ken Umetani, Hiroshi Ijiri, Kiyoshi Koizumi, Tsutomu Araki, Kihachiroh Kamiya, Yuusuke Tada, Kohji Tamura. (1998) Dipyridamole Thallium-201 Single-Photon Emission Computed Tomography for Prediction of Perioperative Cardiac Events in Patients With Arteriosclerosis Obliterans Undergoing Vascular Surgery. Japanese Circulation Journal 62:4, 274-278
CrossRef63
Judith A. Hsia. (1998) CARDIOVASCULAR DISEASES IN WOMEN. Medical Clinics of North America 82:1, 1-19
CrossRef64
P GUERREBERTHELOT, P CRAMA, F PRIMA, C ODDOZE, A BRANCHEREAU, F GOUIN, J AUFFRAY. (1997) Incidence des lésions myocardiques après chirurgie vasculaire: diagnostic par la troponine Ic. Annales Françaises d’Anesthésie et de Réanimation 16:8, 950-954
CrossRef65
S. Renton, P. Hornick, K. M. Taylor, P. A. Grace. (1997) Rational approach to combined carotid and ischaemic heart disease. British Journal of Surgery 84:11, 1503-1510
CrossRef66
Michele Bertrand, Gilles Godet, Marie-Helene Fleron, Marguerite-Anne Bernard, Philippe Orcel, Bruno Riou, Edouard Kieffer, Pierre Coriat. (1997) Lumbar Muscle Rhabdomyolysis After Abdominal Aortic Surgery. Anesthesia & Analgesia 85:1, 11-15
CrossRef67
Joseph Emmerich, Jean-Noël Fiessinger. (1997) Abdominal aortic aneurysm. The Lancet 349:9066, 1699
CrossRef68
Manfred D. Seeberger, Michael K. Cahalan, Edward Chu, Elyse Foster, Pompiliu Ionescu, Michel Balea, Susan Adler, Scott Merrick, Nelson B. Schiller. (1997) Rapid Atrial Pacing for Detecting Provokable Demand Ischemia in Anesthetized Patients. Anesthesia & Analgesia 84:6, 1180-1185
CrossRef69
J Adam van der Vliet, Albert PM Boll. (1997) Abdominal aortic aneurysm. The Lancet 349:9055, 863-866
CrossRef70
H Van Damme. (1997) Cardiac risk assessment before vascular surgery: a prospective study comparing clinical evaluation, dobutamine stress echocardiography, and dobutamine Tc-99m sestamibi tomoscintigraphy. Cardiovascular Surgery 5:1, 54-64
CrossRef71
S. J. HOWELL, Y. M. SEAR, D. YEATES, M. GOLDACRE, J. W. SEAR, P. FOËX. (1996) Hypertension, admission blood pressure and perioperative cardiovascular risk. Anaesthesia 51:11, 1000-1004
CrossRef72
Jean-Claude Tardif, Martin Juneau. (1996) Predicting ischaemic events in the perioperative period: in search of the perfect tool. Canadian Journal of Anaesthesia 43:10, 989-994
CrossRef73
C DEVIRGILIO, S PAK, T ARNELL, C DONAYRE, R LEWIS, B STABILE, R WHITE. (1996) Cardiac Assessment Prior to Vascular Surgery: Is Dipyridamole-Sestamibi Necessary?. Annals of Vascular Surgery 10:4, 325-329
CrossRef74
Jean E. Starr, Norman R. Hertzer, Edward J. Mascha, Patrick J. O'Hara, Leonard P. Krajewski, Timothy M. Sullivan, Edwin G. Beven. (1996) Influence of gender on cardiac risk and survival in patients with infrarenal aortic aneurysms. Journal of Vascular Surgery 23:5, 870-880
CrossRef75
Lee Goldman. (1996) Cardiac risk for vascular surgery. Journal of the American College of Cardiology 27:4, 799-802
CrossRef76
R. N. JUSTE, A. D. LAWSON, N. SONI. (1996) Minimising cardiac anaesthetic risk: the tortoise or the hare?. Anaesthesia 51:3, 255-262
CrossRef77
(1996) Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Journal of the American College of Cardiology 27:4, 910-948
CrossRef78
Leslee J. Shaw, Kim A. Eagle, Bernard J. Gersh, D. Douglas Miller. (1996) Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. Journal of the American College of Cardiology 27:4, 787-798
CrossRef79
Orlando C. Kirton, Joseph M. Civetta, Judith Hudson-Civetta. (1996) COST EFFECTIVENESS IN THE INTENSIVE CARE UNIT. Surgical Clinics of North America 76:1, 175-200
CrossRef80
Robert H. Bode, Keith P. Lewis, Stuart W. Zarich, Eric T. Pierce, Mark Roberts, Glen J. Kowalchuk, Paul R. Satwicz, Gary W. Gibbons, Jennifer A. Hunter, Cynthia C. Espanola, Richard W. Nesto. (1996) Cardiac Outcome after Peripheral Vascular Surgery. Anesthesiology 84:1, 3-13
CrossRef81
Mangano, Dennis T., Goldman, Lee, . (1995) Preoperative Assessment of Patients with Known or Suspected Coronary Disease. New England Journal of Medicine 333:26, 1750-1756
Full Text82
Dennis T. Mangano. (1995) Preoperative Risk Assessment: Many Studies, Few Solutions. Anesthesiology 83:5, 897-901
CrossRef83
Lee A. Fleisher, Stanley H. Rosenbaum, Ann H. Nelson, Diwaker Jain, Frans J. Th Wackers, Barry L. Zaret. (1995) Preoperative Dipyridamole Thallium Imaging and Ambulatory Electrocardiographic Monitoring as a Predictor of Perioperative Cardiac Events and Long-term Outcome. Anesthesiology 83:5, 906-917
CrossRef84
E Marshall. (1995) Adenosine radionuclide perfusion imaging in the preoperative evaluation of patients undergoing peripheral vascular surgery. The American Journal of Cardiology 76:11, 817-821
CrossRef85
Thomas S. Huber, Timothy R.S. Harward, Timothy C. Flynn, Janet L. Albright, James M. Seeger. (1995) Operative mortality rates after elective infrarenal aortic reconstructions. Journal of Vascular Surgery 22:3, 287-294
CrossRef86
Don Poldermans, Mariarosaria Arnese, Paolo M. Fioretti, Alessandro Salustri, Eric Boersma, Ian R. Thomson, Jos R.T.C. Roelandt, Hero Van Urk. (1995) Improved cardiac risk stratification in major vascular surgery with dobutamine-atropine stress echocardiography. Journal of the American College of Cardiology 26:3, 648-653
CrossRef87
Liwa T. Younis, D. Douglas Miller, Bernard R. Chaitman. (1995) Preoperative strategies to assess cardiac risk before noncardiac surgery. Clinical Cardiology 18:8, 447-454
CrossRef88
A. Henderson, D. Effeney. (1995) MORBIDITY AND MORTALITY AFTER ABDOMINAL AORTIC SURGERY IN A POPULATION OF PATIENTS WITH HIGH CARDIOVASCULAR RISK. ANZ Journal of Surgery 65:6, 417-420
CrossRef89
Lee Goldman. (1995) Cardiac Risk in Noncardiac Surgery. Anesthesia & Analgesia 80:4, 810-820
CrossRef90
(1994) Assessment of Cardiac Risk before Abdominal Aortic Surgery. New England Journal of Medicine 331:7, 480-480
Full Text91
Stephen A. Abraham, Kim A. Eagle. (1994) Preoperative cardiac risk assessment for noncardiac surgery. Journal of Nuclear Cardiology 1:4, 389-398
CrossRef92
Goldman, Lee, . (1994) Assessment of Perioperative Cardiac Risk. New England Journal of Medicine 330:10, 707-709
Full Text
- Letters
