Boersma et al developed two models for predicting the risk of a serious cardiac event during or after major vascular surgery with and without beta blocker therapy. The second model used dobutamine stress echocardiography (DSE) in patients based on a cardiac risk score. This can help identify patients who should be considered for cardiac revascularization. The authors are from the DECREASE (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography) Study Group in the Netherlands and Italy.
Vascular surgery was performed for serious peripheral vascular disease or aortic aneurysms.
Cardiac endpoint: postoperative 30 day cardiac death or acute myocardial infarction
Parameters:
(1) cardiac risk index
(2) findings on dobutamine stress echocardiography (DSE)
(3) use of beta-blockers
Cardiac risk index parameters:
(1) age
(2) angina
(3) history of myocardial infarction
(4) congestive heart failure
(5) history of cerebrovascular event
(6) diabetes mellitus
(7) renal failure
|
Cardiac Risk Index Parameters |
Finding |
Points |
|
age in years |
< 70 years |
0 |
|
|
>= 70 years |
1 |
|
angina |
absent |
0 |
|
|
present |
1 |
|
history of myocardial infarction |
absent |
0 |
|
|
present |
1 |
|
congestive heart failure |
absent |
0 |
|
|
present |
1 |
|
history of cerebrovascular event |
absent |
0 |
|
|
present |
1 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
1 |
|
renal failure |
absent |
0 |
|
|
present |
1 |
total risk score =
= SUM(points for all 7 parameters)
Dobutamine stress echocardiography (DSE) was performed if the total risk score was >= 3.
The left ventricle is divided into 16 segments. The motion in each segment is graded from 1 to 5.
|
Wall Motion on DSE |
Grade |
|
normal wall motion |
1 |
|
mild hypokinesis |
2 |
|
severe hypokinesis |
3 |
|
akinesis |
4 |
|
dyskinesis |
5 |
A new wall abnormality in a segment was defined as:
(1) an increase >=1 in the wall motion grade
(2) exclusion: akinesis (Grade 4) to dyskinesis (Grade 5)
Findings on dobuatamine stress echocardiography (DSE) were recorded as:
(1) no new wall motion abnormalities
(2) new wall motion abnormalities seen in 1 to 4 segments
(3) new wall motion abnormalities seen in >= 5 segments
Risk Score 0 to 2
|
Risk Score |
No Beta Blockers Used |
Beta Blockers Used |
|
0 |
1.2% |
0% |
|
1 |
3.0% |
0.9% |
|
2 |
3.0% |
0.9% |
Risk Score >= 3
|
Segments with New Wall Motion |
No Beta Blockers Used |
Beta Blockers Used |
|
0 |
5.8% |
2.0% |
|
1 to 4 |
33% |
2.8% |
|
>= 5 |
33% |
36% |
Specialty: Cardiology, Surgery, general
ICD-10: ,
