Prognosis of patients with vascular disease after clinical evaluation and dobutamine stress echocardiography

Background Coronary disease is an important cause of long-term morbidity in patients needing major vascular surgery. We sought to assess the efficacy of preoperative clinical evaluation and the detection of inducible ischemia for prediction of immediate and long-term cardiac outcomes of patients und ergoing vascular surgery. Methods In 233 patients undergoing vascular procedures, we assessed risk cl inically on the basis of Eagle's criteria. Dobutamine echocardiography was performed with a standard protocol and results were classified as showing i schemia, scar, or a normal response. Patients were observed perioperatively , and late follow-up (28 +/- 13 months) was completed in all surgical survi vors. A composite end point of cardiac death, myocardial infarction, and un stable and progressive angina requiring late revascularization was used to judge event-free survival. Results of 233 patients undergoing preoperative dobutamine echocardiography , 39 (17%) had inducible ischemia and 36 (15%) had scar. Perioperative even ts occurred in 8 patients (3%). None of the patients with ischemia had peri operative events, reflecting the effect of revascularization in 9 patients. late events occurred in 36 patients; ischemia on preoperative stress testi ng was a predictor of these events even after adjusting for clinical variab les and left ventricular dysfunction (relative risk = 3.3; 95% confidence i nterval 1.6 to 6.8; P = .001). The association of ischemia with clinical pr edictors was associated with incrementally worse outcome. Conclusion In addition to perioperative assessment, the combined use of cli nical and dobutamine echocardiographic evaluation may stratify the risk of late cardiac events.