Preoperative Cardiac Risk Assessment for Patients Having Peripheral Vascular Surgery
Preoperative Cardiac Risk Assessment for Patients Having Peripheral Vascular Surgery
复制标题
周围血管手术患者的术前心脏风险评估
DOI：
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发表时间：
1992
影响因子：
39.2
通讯作者：
A. Detsky
中科院分区：
文献类型：
--
作者：
T. Wong;A. Detsky
目的
综述外周血管手术患者术前心脏危险分层的方法。
数据源
1991年8月之前发表的相关研究使用MEDLINE检索英语文献，然后手动检索所有识别文章的参考文献。
资料选择
所有评价外周血管手术患者术前心脏风险分层方法的临床研究。
数据提取
从每篇文章中提取的关键数据包括研究患者的入选和排除标准，用于检测的技术和阳性检测结果的相应定义，以及受试患者的临床结局。使用贝叶斯概念框架对数据进行分析，并使用似然比计算将前测概率转换为后测概率。
结果
临床心脏风险指数得分高的患者（戈德曼指数大于12或Detsky指数大于15），或Eagle确定的三个以上标准（年龄大于70岁，糖尿病，心绞痛，心电图Q波或室性心律失常）可能是血管手术后心脏死亡和心肌梗死的风险较高。那些既得分低又不符合Eagle标准的人可能风险较低，但独立研究尚未重现这一结果。两组患者都不会从进一步的心脏风险分层研究中获益。符合这些标准中的一个或两个的患者可能处于中等风险，并将从进一步的风险分层测试中获益最多。大多数已发表的证据表明，在双嘧达莫-铊扫描中没有再分布可确定术后心脏并发症的低风险，而存在再分布则预示着高风险。初步报告表明，术前监测无症状心肌缺血也可能有助于识别高风险的患者子集。
结论
临床上确定为外周血管手术后心脏并发症风险极低或极高的患者不太可能从进一步的风险分层中获益。双嘧达莫-铊扫描是进一步评估中等临床风险患者的首选检查，因为研究表明，它足够敏感，可以排除没有再分布的患者的高风险状态。
PURPOSE
To review the methods used for preoperative cardiac risk stratification of patients having peripheral vascular surgery.
DATA SOURCES
Relevant studies published before August 1991 were identified using a MEDLINE search of the English-language literature, followed by a manual search of the references of all identified articles.
STUDY SELECTION
All clinical studies evaluating methods used for preoperative cardiac risk stratification of patients having peripheral vascular surgery.
DATA EXTRACTION
The key data extracted from each article included the inclusion and exclusion criteria of the study patients, the techniques used for testing and the corresponding definitions of positive test results, and the clinical outcomes of the tested patients. Data were analyzed using a Bayesian conceptual framework, and pretest probabilities were converted to post-test probabilities using calculation of likelihood ratios.
RESULTS
Patients with high scores on clinical cardiac risk indexes (Goldman index greater than 12 or Detsky index greater than 15), or more than three of the criteria identified by Eagle (age greater than 70 years, diabetes, angina, Q waves on electrocardiogram, or ventricular arrhythmias) are likely to be at higher risk for cardiac death and myocardial infarction after vascular surgery. Those with both low scores and none of Eagle's criteria may be at lower risk, but this result has not been reproduced by independent studies. Neither group of patients would benefit from further investigation for cardiac risk stratification. Patients with one or two of these criteria may be at intermediate risk and would benefit most from further testing for the purposes of risk stratification. Most of the published evidence shows that the absence of redistribution on dipyridamole-thallium scanning identifies a low risk for postoperative cardiac complications, whereas the presence of redistribution predicts a high risk. Preliminary reports suggest that preoperative monitoring for silent myocardial ischemia may also be useful in identifying a high-risk subset of patients.
CONCLUSIONS
Patients identified clinically to be at either very low or high risk for cardiac complications after peripheral vascular surgery are unlikely to benefit from further risk stratification. Dipyridamole-thallium scanning is the test of choice for further evaluation of patients at intermediate clinical risk because studies have shown that it is sensitive enough to rule out a high-risk status for patients who do not have redistribution.
术后心电图和肌酸激酶：对非心脏手术后心肌梗死诊断的影响。
影响因子：
7.2
作者：
Charlson,ME;MacKenzie,CR;Ales,KL;Gold,JP;FaircloughJr,GF;Shires,GT
通讯作者：
Shires,GT
围手术期心肌缺血：术前缺血模式的重要性。
影响因子：
8.8
作者：
Knight,AA;Hollenberg,M;London,MJ;Tubau,J;Verrier,E;Browner,W;Mangano,DT
通讯作者：
Mangano,DT