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Titolo:
Long-term prognostic value of preoperative dipyridamole thallium imaging and clinical indexes in patients with diabetes mellitus undergoing peripheral vascular surgery
Autore:
Cohen, MC; Curran, PJ; LItalien, GJ; Mittleman, MA; Zarich, SW;
Indirizzi:
Maine Med Ctr, Dept Med, Div Cardiol, Portland, ME 04102 USA Maine Med Ctr Portland ME USA 04102 , Div Cardiol, Portland, ME 04102 USA Univ Vermont, Coll Med, Burlington, VT USA Univ Vermont Burlington VT USA niv Vermont, Coll Med, Burlington, VT USA Harvardn,niv, Sch Med, Beth Israel Deaconess Med Ctr, Div Cardiovasc, Bosto Harvard Univ Boston MA USA rael Deaconess Med Ctr, Div Cardiovasc, Bosto Yale Univ, Sch Med, Bridgeport osp, Div Cardiovasc, Bridgeport, CT USA Yale Univ Bridgeport CT USA port osp, Div Cardiovasc, Bridgeport, CT USA Yale Univ, Sch Med, Bridgeport osp, Div Cardiol, Bridgeport, CT USA Yale Univ Bridgeport CT USA dgeport osp, Div Cardiol, Bridgeport, CT USA Bristol Meyer Squibb, Malcolm Grow Med Ctr, Dept Med, Bridgeport, CT USA Bristol Meyer Squibb Bridgeport CT USA Ctr, Dept Med, Bridgeport, CT USA
Titolo Testata:
AMERICAN JOURNAL OF CARDIOLOGY
fascicolo: 7, volume: 83, anno: 1999,
pagine: 1038 - 1042
SICI:
0002-9149(19990401)83:7<1038:LPVOPD>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
LATE CARDIAC EVENTS; NONCARDIAC SURGERY; RISK; SCINTIGRAPHY; PREDICTION; DISEASE; INFARCTION; TOMOGRAPHY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Cohen, MC Maine Cardiol Associates, 66 Bramhall St, Portland, ME 04102 USAMaine Cardiol Associates 66 Bramhall St Portland ME USA 04102 SA
Citazione:
M.C. Cohen et al., "Long-term prognostic value of preoperative dipyridamole thallium imaging and clinical indexes in patients with diabetes mellitus undergoing peripheral vascular surgery", AM J CARD, 83(7), 1999, pp. 1038-1042

Abstract

he objective of this study is to assess the prognostic impact of preoperative dipyridamole thallium imaging and clinical variables on the long-term outcome of diabetic patients undergoing peripheral vascular surgery. Complete follow-up was obtained in 101 consecutive patients with diabetes mellitusundergoing routine dipyridamole thallium scintigraphy before vascular surgery (mean 4.2 +/- 3.2 years, range 1 month to 11 years), low risk was defined by diabetes alone with a normal resting electrocardiogram, High risk wasdefined as a history of angina, myocardial infarction, congestive heart failure, or resting electrocardiogram abnormalities, There were 71 deaths in 98 patients discharged alive from the hospital (median survival 4.4 years),Age, the presence of resting electrocardiogram abnormalities, and an abnormal thallium scan were independent predictors of late death. After adjusting for age >70 years and thallium abnormalities, high-risk patients had a death rate 4.8 times (95% confidence interval 1.7 to 13.4, p <0.002) greater than low-risk patients. The presence of >2 reversible thallium defects was useful in further risk stratification of both low- and high-risk patients, Low-risk patients with >2 reversible defects had a median survival of 4.0 years compared with 9.4 years in those with less than or equal to 2 reversible defects (p < 0.001), Similarly, high-risk patients with less than or equal to 2 reversible defects had an intermediate median survival rate of 4.7 years compared with 1.8 years in the group with >2 reversible defects (p < 0.001), Therefore, advanced age and the presence of resting electrocardiographic or thallium abnormalities identifies a subset of diabetic patients with a poor longterm outcome after vascular surgery. Combined clinical and thallium variables may identify a population in whom intensive medical or surgical interventions may be warranted to reduce both perioperative and late cardiac events. (C) 1999 by Excerpta Medica, Inc.

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Documento generato il 27/11/20 alle ore 07:27:50