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Validation of an updated approach to preoperative cardiac risk assessment in vascular surgery
Hao Bui1, Jason T Lee, Scott Greenway
1Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA.
Insights
A selective cardiac assessment protocol for vascular surgery patients reduced stress testing and coronary artery bypass grafting. Cardiac morbidity and mortality remained unchanged, validating a more targeted approach to cardiac evaluation.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Cardiac assessment is crucial for patients undergoing major vascular surgery.
- Previous protocols may have involved extensive cardiac work-up.
- Optimizing cardiac assessment can improve patient outcomes and resource allocation.
Purpose of the Study:
- To validate a selective cardiac assessment strategy for major vascular surgery.
- To compare cardiac work-up, morbidity, and mortality between two distinct time periods with differing cardiac assessment protocols.
Main Methods:
- Retrospective review of patients undergoing vascular procedures.
- Comparison of data from 1994-1995 (standard protocol) and 2000-2001 (selective protocol).
- Analysis of preoperative stress testing, coronary revascularization, and cardiac events.
Main Results:
- Preoperative stress testing decreased significantly (29% to 14%) with the selective protocol.
- Preoperative coronary artery bypass grafting also reduced (4.1% to 1.4%).
- Cardiac event rates and cardiac death were similar between the two groups.
Conclusions:
- A more selective approach to cardiac assessment in vascular surgery is feasible.
- Reduced stress testing and revascularization did not increase cardiac morbidity or mortality.
- This strategy allows for targeted cardiac evaluation in high-risk patients.
Abstract:
To validate a more selective approach to cardiac assessment which consisted of limiting stress testing and coronary revascularization to highly selected patients and limiting coronary revascularization to patients with severe cardiac symptoms, we compared two time periods (1994-1995 and 2000-2001) with respect to cardiac work-up and cardiac morbidity and mortality. Our method involved a retrospective review of patients undergoing vascular procedures from 2000 to 2001 at a single institution. In group 1 (2000-2001), 139 operations were performed on 120 patients. In group 2 (1994-1995), 145 procedures were performed on 109 patients. Preoperative stress testing was reduced from 42 patients (29%) in group 2 to 20 patients (14%) in group 1 (P < 0.01), and preoperative coronary artery bypass grafting was reduced from six (4.1%) to two (1.4%) (P < 0.28), respectively. Coronary angiography was unchanged: 8 (5.8%) patients in group 1 versus 11 (7.9%) patients in group 2 (P = NS). Two (1.4%) patients underwent percutaneous transluminal coronary angioplasty in group 1 and group 2. Cardiac event rates were similar: seven (5%) patients in both groups. Cardiac death was not significantly different: two (1.4%) in group 1 versus one (0.7%) in group 2. Cardiac morbidity and mortality after major vascular surgery remain the same despite using a more selective cardiac stress protocol.
