말초동맥폐쇄증 환자에서 술전 심위험도 평가 = Preoperative Cardiac Risk Assessment for Patients Having Peripheral Vascular Surgery

다국어 초록 (Multilingual Abstract)

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 Goldmans index, Detskys 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%', Class III(n=3), 66.6 %; and Class IV(n=l), 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 points(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 Eagles 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 clinical cardiac risk indexes(Goldman index $gt;l2 or Detsky index $gt;15), or more than three of Eagles criteria are likely to be at higher risk for cardiac death after vascular surgery.