The limits of generalized cardiac screening tests for predicting cardiac complications after infrainguinal arterial reconstruction

John H. Matsuura, Michael Sobel, Jonathon Wong, Jeffery Dattilo, Larry F. Poletti, Raymond G. Makhoul, Marc P. Posner, Hyung M. Lee

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    We examined the relative efficacies of different cardiac screening strategies for infrainguinal arterial bypass. The outcomes of 205 elective leg bypass procedures over a 10-year period, including myocardial infarction (MI), total cardiac complications, and mortality were tallied. Clinical risk factors popularized by Goldman and Eagle, and the results of dipyridamole thallium myocardial imaging (DThal) were recorded. The overall mortality rate was 3.4%, with a 3.4% incidence of MI and a 5.4% total cardiac complication rate. Both abnormal DThal (p = 0.011) and Goldman class II-IV (p = 0.030) were significant predictors of MI and cardiac death, but both suffered from poor specificity and positive predictive value. Because logistic regression analysis identified a correlation between angina, CHF, and an abnormal DThal, a customized screening strategy was developed to include the presence of angina, CHF and an abnormal DThal. Eighty-eight percent of patients suffering MI or death met these criteria, while only 11% of the complication-free group did. This screening strategy provided a superior sensitivity of 88%, specificity of 89%, positive predictive value of 25%, and 99% negative predictive value. A customized screening strategy (angina, CHF, abnormal DThal), developed from a 10-year experience with a single patient group, provided better predictive accuracy than any generalized screening formula.

    Original languageEnglish (US)
    Pages (from-to)620-625
    Number of pages6
    JournalAnnals of Vascular Surgery
    Volume11
    Issue number6
    DOIs
    StatePublished - Jan 1 1997

    Fingerprint

    Myocardial Infarction
    Eagles
    Dipyridamole
    Mortality
    Thallium
    Leg
    Logistic Models
    Regression Analysis
    Sensitivity and Specificity
    Incidence

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    The limits of generalized cardiac screening tests for predicting cardiac complications after infrainguinal arterial reconstruction. / Matsuura, John H.; Sobel, Michael; Wong, Jonathon; Dattilo, Jeffery; Poletti, Larry F.; Makhoul, Raymond G.; Posner, Marc P.; Lee, Hyung M.

    In: Annals of Vascular Surgery, Vol. 11, No. 6, 01.01.1997, p. 620-625.

    Research output: Contribution to journalArticle

    Matsuura, JH, Sobel, M, Wong, J, Dattilo, J, Poletti, LF, Makhoul, RG, Posner, MP & Lee, HM 1997, 'The limits of generalized cardiac screening tests for predicting cardiac complications after infrainguinal arterial reconstruction', Annals of Vascular Surgery, vol. 11, no. 6, pp. 620-625. https://doi.org/10.1007/s100169900100
    Matsuura, John H. ; Sobel, Michael ; Wong, Jonathon ; Dattilo, Jeffery ; Poletti, Larry F. ; Makhoul, Raymond G. ; Posner, Marc P. ; Lee, Hyung M. / The limits of generalized cardiac screening tests for predicting cardiac complications after infrainguinal arterial reconstruction. In: Annals of Vascular Surgery. 1997 ; Vol. 11, No. 6. pp. 620-625.
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