CARDIAC EVALUATION OF THE DIABETIC PATIENT PRIOR TO PERIPHERAL VASCULAR-SURGERY

The benefit of preoperative cardiac evaluation in the diabetic patient undergoing peripheral vascular surgery is uncertain. To investigate t his issue we performed a retrospective review of 192 procedures perfor med in diabetic patients for chronic lower extremity arterial occlusiv e disease. The incidence of adverse postoperative cardiac events was d etermined, as well as its association with several preoperative factor s including symptoms of coronary artery disease (CAD), extent and resu lts of preoperative noninvasive cardiac evaluation, and operative site (aorta vs. lower extremity). The overall death and cardiac complicati on rates were 10.2% for lower extremity and 25.7% for aortic procedure s (p = 0.02). For myocardial infarction and cardiac death alone, the r ates were 5.1% and 5.7%, respectively (p > 0.10). Although a history o f symptomatic CAD predicted the occurrence of any cardiac complication (28.3% vs. 8.2% [p < 0.01] for the aortic and lower extremity revascu larization groups combined), no factor was found to be associated with the occurrence of myocardial infarction and cardiac death alone. In p atients with a history of symptomatic CAD, there was no significant di fference 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 re view of our experience with noninvasive evaluation to detect CAD in di abetic patients undergoing peripheral vascular surgery failed to show any benefit in terms of reducing the incidence of postoperative cardia c events.