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KMID : 0357019960120020217
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Journal of the Korean Vascular Surgery Society
1996 Volume.12 No. 2 p.217 ~ p.223
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Preoperative Cardiac Risk Assessment of Patients Having Peripheral Vascular Surgery
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Abstract
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Patients undergoing peripheral arterial procedures are at increased risk for postoperative cardiac complications and are difficult to assess preoperatively because of limitations on their activity. Preoperative identification of high-risk
patients
is
important both for a proper assessment of the risk-benefit ratio for surgery and to allow more intense perioperative management of those at high risk to reduce complication rates. An inexpensive approach to stratification of patients admitted for
arterial surgery into groups of high and low cardiac risk has been retrospectively evaluated in 43 patients over 50 years of age. Cardiac risk was calculated according to Goldman's index, Detsky's index, or the criteria identified by Eagle(age>70
years,
diabetes, angina, Q wave on electrocardiogram, or ventricular arrhythmia). Of the 43 patients 4(9.3%) patients had postoperative cardiac death. When Goldman's index was applied to the patients, the cardiac death ratios for each risk class were as
follows: Class I(n=32), 3.1%; Class Ⅱ(n=7), 0%; ClassⅢ(n=3), 66.6%; and ClassⅣ(n=1), 100%. When Detsky's index was applid to the patients, cardiac death ratios were 2.5% in the patients having Detsky's risk scores of 0 to 15 oints(n=40 and
100%
in
the patients having 20 points or more(n=3). When the patients were classified into three groups according to Eagle's criteria, the cardiac risk ratios for each group were as follows: Patients with none of Eagle's criteria(n=22), 0%; patients with
one or
two of these criteria(n=19), 15.7%; and patients with three or more of these criteria(n=2), 50.0%. We conclude that patients with high scores on chnical cardiac risk indexes(Goldman index>12 or Detsky index >15), or more than three of Eagle's
criteria
are likely to be at higher risk for cardiac deathafter vascular surgery.
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KEYWORD
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