Showing papers by "Kim A. Eagle published in 1987"
TL;DR: The data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events and suggested that clinical factors might allow identification of a low-risk subset of patients.
Abstract: Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning.
277 citations
TL;DR: The input of Dr Meyer and Drs Kleinman and Smith in correcting a misnomer in the article is appreciated and the means of the DrippsASA scores in Table 1 of the article are compared.
Abstract: In Reply.— We were pleased with the interest shown in our recent article. We appreciate the input of Dr Meyer and Drs Kleinman and Smith in correcting a misnomer in our article, which we had perpetuated from a prior study of preoperative risk assessment. 1 The ASA classification system is not related to the American Surgical Association, but rather the American Society of Anesthesiologists. Dr Meyer also objects to our comparing the means of the DrippsASA scores in Table 1 of our article. We could have instead used threshold values of the ASA scores. Regardless of the cutoff, more patients with complications exceed the threshold than patients without complications. However, two (25%) patients with postoperative ischemic events had ASA scores of 2.0 and three more had ASA scores of 3.0. Thus, all but very low threshold values for ASA scores will miss a large fraction of the patients who will
84 citations