PMID- 17132653
OWN - NLM
STAT- MEDLINE
DCOM- 20071109
LR  - 20161124
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 28
IP  - 5
DP  - 2007 Mar
TI  - A clinical survival score predicts the likelihood to benefit from preoperative 
      thallium scanning and coronary revascularization before major vascular surgery.
PG  - 533-9
AB  - AIMS: Guidelines advocate selective non-invasive testing before major non-cardiac 
      surgery, yet data defining who may benefit from such tests is lacking. We aimed 
      to find the predictors that define patients who are most likely to benefit from 
      preoperative cardiac testing and coronary revascularization (CR). METHODS AND 
      RESULTS: In 624 consecutive major vascular surgery patients, the preoperative 
      thallium scanning (PTS) results and subsequent CRs were correlated with long-term 
      (3-15 years) survival. Of all patients, 510 (80.6%) had PTS, 154 (24.7%) had 
      moderate-severe ischaemia on PTS, and 96 (15.4%) underwent CR. Seven predictors: 
      age >or=65, diabetes, cerebrovascular disease, ischaemic heart disease, 
      congestive heart failure, ST-depression on preoperative ECG, and renal 
      insufficiency, independently determined long-term survival. A long-term survival 
      score (LTSS) comprised of these predictors, divided all patients into low, 
      intermediate, and high-risk groups (0-1, 2-3, >or=4 predictors, respectively) 
      with a 5-year survival of 83 +/- 2%, 60 +/- 3%, and 34 +/- 6%, respectively. 
      Compared with low-risk patients, intermediate and high-risk patients had worse 
      survival [HR (CI) = 2.6 (2.0-3.4) and 5.9 (4.1-8.9), respectively, P < 0.001]. 
      Yet, only the intermediate-risk group had better long-term survival following 
      preoperative CR [HR = 0.48 (0.31-0.75), P = 0.001]. The low-risk groups' 
      favourable survival and high-risk groups' poor survival were not significantly 
      affected by CR. CONCLUSION: Intermediate-risk patients (LTSS 2-3) are most likely 
      to have a long-term survival benefit from PTS and CR.
FAU - Landesberg, Giora
AU  - Landesberg G
AD  - Department of Anaesthesiology, Hebrew University, Hadassah Medical Center, 
      Jerusalem 91120, Israel. gio@cc.huji.ac.il
FAU - Berlatzky, Yacov
AU  - Berlatzky Y
FAU - Bocher, Moshe
AU  - Bocher M
FAU - Alcalai, Ron
AU  - Alcalai R
FAU - Anner, Haim
AU  - Anner H
FAU - Ganon-Rozental, Tatyana
AU  - Ganon-Rozental T
FAU - Luria, Myron H
AU  - Luria MH
FAU - Akopnik, Inna
AU  - Akopnik I
FAU - Weissman, Charles
AU  - Weissman C
FAU - Mosseri, Morris
AU  - Mosseri M
LA  - eng
PT  - Journal Article
DEP - 20061128
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Thallium Radioisotopes)
SB  - IM
CIN - Eur Heart J. 2007 Mar;28(5):519-21. PMID: 17317701
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/methods
MH  - Female
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Myocardial Ischemia/diagnostic imaging/mortality/*prevention & control
MH  - Myocardial Revascularization/*methods/mortality
MH  - Postoperative Complications/mortality/*prevention & control
MH  - Preoperative Care/*methods/mortality
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stents
MH  - Survival Analysis
MH  - *Thallium Radioisotopes
MH  - Tomography, Emission-Computed, Single-Photon/methods
MH  - Vascular Diseases/diagnostic imaging/mortality/*surgery
EDAT- 2006/11/30 09:00
MHDA- 2007/11/10 09:00
CRDT- 2006/11/30 09:00
PHST- 2006/11/30 09:00 [pubmed]
PHST- 2007/11/10 09:00 [medline]
PHST- 2006/11/30 09:00 [entrez]
AID - ehl390 [pii]
AID - 10.1093/eurheartj/ehl390 [doi]
PST - ppublish
SO  - Eur Heart J. 2007 Mar;28(5):533-9. doi: 10.1093/eurheartj/ehl390. Epub 2006 Nov 
      28.