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Cardiac evaluation of the diabetic patient prior to peripheral vascular surgery
D B Hood1, F A Weaver, G Papanicolaou
1Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Insights
Preoperative cardiac evaluation for diabetic patients undergoing peripheral vascular surgery did not reduce adverse cardiac events. This study found no benefit from noninvasive testing in predicting myocardial infarction or cardiac death in this patient group.
Area of Science:
- Cardiology
- Vascular Surgery
- Diabetic Medicine
Background:
- Diabetic patients undergoing peripheral vascular surgery face uncertain cardiac risks.
- Preoperative cardiac evaluation aims to mitigate these risks, but its benefit is debated.
Purpose of the Study:
- To evaluate the effectiveness of preoperative cardiac evaluation in diabetic patients undergoing peripheral vascular surgery.
- To determine if preoperative noninvasive cardiac testing reduces adverse postoperative cardiac events.
Main Methods:
- Retrospective review of 192 procedures in diabetic patients with chronic lower extremity arterial occlusive disease.
- Analysis of factors including coronary artery disease (CAD) symptoms, noninvasive cardiac testing results, and operative site.
- Comparison of cardiac complication rates between different patient subgroups.
Main Results:
- Overall death and cardiac complication rates were higher for aortic procedures (25.7%) compared to lower extremity procedures (10.2%).
- History of symptomatic CAD predicted overall cardiac complications but not myocardial infarction or cardiac death.
- Preoperative noninvasive cardiac testing showed no significant difference in complication rates, regardless of test results or patient history.
Conclusions:
- Preoperative noninvasive cardiac evaluation did not demonstrate a benefit in reducing postoperative cardiac events in diabetic patients undergoing peripheral vascular surgery.
- Further research may be needed to optimize cardiac risk assessment in this high-risk population.
Abstract:
The benefit of preoperative cardiac evaluation in the diabetic patient undergoing peripheral vascular surgery is uncertain. To investigate this issue we performed a retrospective review of 192 procedures performed in diabetic patients for chronic lower extremity arterial occlusive disease. The incidence of adverse postoperative cardiac events was determined, as well as its association with several preoperative factors including symptoms of coronary artery disease (CAD), extent and results of preoperative noninvasive cardiac evaluation, and operative site (aorta vs. lower extremity). The overall death and cardiac complication rates were 10.2% for lower extremity and 25.7% for aortic procedures (p = 0.02). For myocardial infarction and cardiac death alone, the rates were 5.1% and 5.7%, respectively (p > 0.10). Although a history of symptomatic CAD predicted the occurrence of any cardiac complication (28.3% vs. 8.2% [p < 0.01] for the aortic and lower extremity revascularization groups combined), no factor was found to be associated with the occurrence of myocardial infarction and cardiac death alone. In patients with a history of symptomatic CAD, there was no significant difference in the incidence of complications whether or not preoperative noninvasive cardiac testing was performed (28.1% vs. 28.6%, p > 0.10) or, if testing was performed, if the results were abnormal or normal (35.3% vs. 20.0%, p > 0.10). Similar results were obtained in patients with no history of symptomatic CAD. In summary, this retrospective review of our experience with noninvasive evaluation to detect CAD in diabetic patients undergoing peripheral vascular surgery failed to show any benefit in terms of reducing the incidence of postoperative cardiac events.