Matches in SemOpenAlex for { <https://semopenalex.org/work/W2005643172> ?p ?o ?g. }
- W2005643172 endingPage "45" @default.
- W2005643172 startingPage "38" @default.
- W2005643172 abstract "ObjectivePatients undergoing infrainguinal arterial reconstruction frequently have increased cardiac risk factors. Diabetic patients are often asymptomatic despite advanced cardiac disease. This study investigates whether preoperative cardiac testing improves the outcome in diabetic patients at risk for cardiac disease.MethodsWe retrospectively reviewed all patients undergoing lower-extremity arterial reconstructions in a 32-month period from July 1999 to February 2002. Of the 433 patients identified undergoing 539 procedures, 295 had diabetes mellitus and considered in this study. The patients were stratified into two groups according to the present American College of Cardiology, American Heart Association (ACC/AHA) algorithm. We identified 140 patients with two or more of ACC (Eagle) criteria who met the inclusion criteria for a preoperative cardiac evaluation. These patients were separated into two groups: those undergoing a cardiac work-up (WU) according to the ACC/AHA algorithm and those not undergoing the recommended work-up (NWU). Outcomes included perioperative mortality, postoperative myocardial infarction, congestive heart failure, arrhythmia, and length of hospitalization. Significance of association was assessed by the Fisher exact test. Length of hospitalization was compared using the Kruskal-Wallis rank sum test. Survival data was analyzed with the Kaplan-Meier method.ResultsOne hundred forty patients met the criteria for moderate risk. There were 61 patients in the NWU group and 79 in the WU group. Ten patients in the WU group underwent preoperative coronary revascularization (6 had percutaneous transluminal coronary angioplasty, 4 underwent coronary artery bypass grafting). There was no difference between perioperative mortality (WU, 1%; NWU, 2%; P = 1.00) or in postoperative cardiac morbidity, including myocardial infarction, congestive heart failure, and arrhythmia requiring treatment (WU, 5%; NWU, 6%; P = .71). There were no perioperative deaths and one episode of congestive heart failure in the group that had preoperative coronary revascularization. Median length of hospitalization was 10 days in the WU group and 8 days in the NWU group (P = .11). Patient survival at 12 months for the NWU, WU, and revascularized groups was 85.3%, 78.5%, and 80.0%, respectively; 36-month survival was 73.6%, 62.9%, and 80.0%, respectively. The three survival curves did not differ significantly (P = .209).ConclusionsPreoperative cardiac evaluation, as defined by the ACC/AHA algorithm, does not predict or improve postoperative morbidity, mortality, or 36-month survival in asymptomatic, diabetic patients undergoing elective lower-extremity arterial reconstruction. These data do not support the current ACC/AHA recommendations as a standard of care for diabetic patients with an intermediate clinical predictor who undergo peripheral arterial reconstruction, a high-risk surgical procedure. Patients undergoing infrainguinal arterial reconstruction frequently have increased cardiac risk factors. Diabetic patients are often asymptomatic despite advanced cardiac disease. This study investigates whether preoperative cardiac testing improves the outcome in diabetic patients at risk for cardiac disease. We retrospectively reviewed all patients undergoing lower-extremity arterial reconstructions in a 32-month period from July 1999 to February 2002. Of the 433 patients identified undergoing 539 procedures, 295 had diabetes mellitus and considered in this study. The patients were stratified into two groups according to the present American College of Cardiology, American Heart Association (ACC/AHA) algorithm. We identified 140 patients with two or more of ACC (Eagle) criteria who met the inclusion criteria for a preoperative cardiac evaluation. These patients were separated into two groups: those undergoing a cardiac work-up (WU) according to the ACC/AHA algorithm and those not undergoing the recommended work-up (NWU). Outcomes included perioperative mortality, postoperative myocardial infarction, congestive heart failure, arrhythmia, and length of hospitalization. Significance of association was assessed by the Fisher exact test. Length of hospitalization was compared using the Kruskal-Wallis rank sum test. Survival data was analyzed with the Kaplan-Meier method. One hundred forty patients met the criteria for moderate risk. There were 61 patients in the NWU group and 79 in the WU group. Ten patients in the WU group underwent preoperative coronary revascularization (6 had percutaneous transluminal coronary angioplasty, 4 underwent coronary artery bypass grafting). There was no difference between perioperative mortality (WU, 1%; NWU, 2%; P = 1.00) or in postoperative cardiac morbidity, including myocardial infarction, congestive heart failure, and arrhythmia requiring treatment (WU, 5%; NWU, 6%; P = .71). There were no perioperative deaths and one episode of congestive heart failure in the group that had preoperative coronary revascularization. Median length of hospitalization was 10 days in the WU group and 8 days in the NWU group (P = .11). Patient survival at 12 months for the NWU, WU, and revascularized groups was 85.3%, 78.5%, and 80.0%, respectively; 36-month survival was 73.6%, 62.9%, and 80.0%, respectively. The three survival curves did not differ significantly (P = .209). Preoperative cardiac evaluation, as defined by the ACC/AHA algorithm, does not predict or improve postoperative morbidity, mortality, or 36-month survival in asymptomatic, diabetic patients undergoing elective lower-extremity arterial reconstruction. These data do not support the current ACC/AHA recommendations as a standard of care for diabetic patients with an intermediate clinical predictor who undergo peripheral arterial reconstruction, a high-risk surgical procedure." @default.
- W2005643172 created "2016-06-24" @default.
- W2005643172 creator A5001256671 @default.
- W2005643172 creator A5002412989 @default.
- W2005643172 creator A5015372457 @default.
- W2005643172 creator A5023816128 @default.
- W2005643172 creator A5027783423 @default.
- W2005643172 creator A5044684651 @default.
- W2005643172 creator A5047892382 @default.
- W2005643172 creator A5060522857 @default.
- W2005643172 date "2005-01-01" @default.
- W2005643172 modified "2023-10-13" @default.
- W2005643172 title "Preoperative cardiac evaluation does not improve or predict perioperative or late survival in asymptomatic diabetic patients undergoing elective infrainguinal arterial reconstruction" @default.
- W2005643172 cites W1669050478 @default.
- W2005643172 cites W1980717583 @default.
- W2005643172 cites W1991971755 @default.
- W2005643172 cites W2009640960 @default.
- W2005643172 cites W2015933619 @default.
- W2005643172 cites W2019203379 @default.
- W2005643172 cites W2022655919 @default.
- W2005643172 cites W2040774583 @default.
- W2005643172 cites W2052446045 @default.
- W2005643172 cites W2069562917 @default.
- W2005643172 cites W2073429865 @default.
- W2005643172 cites W2088338551 @default.
- W2005643172 cites W2091631718 @default.
- W2005643172 cites W2101888501 @default.
- W2005643172 cites W2113126701 @default.
- W2005643172 cites W2132156485 @default.
- W2005643172 cites W2331274940 @default.
- W2005643172 doi "https://doi.org/10.1016/j.jvs.2004.08.059" @default.
- W2005643172 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/15696041" @default.
- W2005643172 hasPublicationYear "2005" @default.
- W2005643172 type Work @default.
- W2005643172 sameAs 2005643172 @default.
- W2005643172 citedByCount "39" @default.
- W2005643172 countsByYear W20056431722012 @default.
- W2005643172 countsByYear W20056431722013 @default.
- W2005643172 countsByYear W20056431722014 @default.
- W2005643172 countsByYear W20056431722015 @default.
- W2005643172 countsByYear W20056431722016 @default.
- W2005643172 countsByYear W20056431722017 @default.
- W2005643172 countsByYear W20056431722022 @default.
- W2005643172 crossrefType "journal-article" @default.
- W2005643172 hasAuthorship W2005643172A5001256671 @default.
- W2005643172 hasAuthorship W2005643172A5002412989 @default.
- W2005643172 hasAuthorship W2005643172A5015372457 @default.
- W2005643172 hasAuthorship W2005643172A5023816128 @default.
- W2005643172 hasAuthorship W2005643172A5027783423 @default.
- W2005643172 hasAuthorship W2005643172A5044684651 @default.
- W2005643172 hasAuthorship W2005643172A5047892382 @default.
- W2005643172 hasAuthorship W2005643172A5060522857 @default.
- W2005643172 hasBestOaLocation W20056431721 @default.
- W2005643172 hasConcept C126322002 @default.
- W2005643172 hasConcept C134018914 @default.
- W2005643172 hasConcept C141071460 @default.
- W2005643172 hasConcept C164705383 @default.
- W2005643172 hasConcept C2777910003 @default.
- W2005643172 hasConcept C2778198053 @default.
- W2005643172 hasConcept C2778213512 @default.
- W2005643172 hasConcept C2780326628 @default.
- W2005643172 hasConcept C31174226 @default.
- W2005643172 hasConcept C500558357 @default.
- W2005643172 hasConcept C555293320 @default.
- W2005643172 hasConcept C71924100 @default.
- W2005643172 hasConcept C78085059 @default.
- W2005643172 hasConceptScore W2005643172C126322002 @default.
- W2005643172 hasConceptScore W2005643172C134018914 @default.
- W2005643172 hasConceptScore W2005643172C141071460 @default.
- W2005643172 hasConceptScore W2005643172C164705383 @default.
- W2005643172 hasConceptScore W2005643172C2777910003 @default.
- W2005643172 hasConceptScore W2005643172C2778198053 @default.
- W2005643172 hasConceptScore W2005643172C2778213512 @default.
- W2005643172 hasConceptScore W2005643172C2780326628 @default.
- W2005643172 hasConceptScore W2005643172C31174226 @default.
- W2005643172 hasConceptScore W2005643172C500558357 @default.
- W2005643172 hasConceptScore W2005643172C555293320 @default.
- W2005643172 hasConceptScore W2005643172C71924100 @default.
- W2005643172 hasConceptScore W2005643172C78085059 @default.
- W2005643172 hasIssue "1" @default.
- W2005643172 hasLocation W20056431721 @default.
- W2005643172 hasLocation W20056431722 @default.
- W2005643172 hasOpenAccess W2005643172 @default.
- W2005643172 hasPrimaryLocation W20056431721 @default.
- W2005643172 hasRelatedWork W2008963736 @default.
- W2005643172 hasRelatedWork W2011390101 @default.
- W2005643172 hasRelatedWork W2049776456 @default.
- W2005643172 hasRelatedWork W2097753790 @default.
- W2005643172 hasRelatedWork W2562811035 @default.
- W2005643172 hasRelatedWork W2781494228 @default.
- W2005643172 hasRelatedWork W3044331089 @default.
- W2005643172 hasRelatedWork W3119120477 @default.
- W2005643172 hasRelatedWork W4210341061 @default.
- W2005643172 hasRelatedWork W4230540696 @default.
- W2005643172 hasVolume "41" @default.
- W2005643172 isParatext "false" @default.
- W2005643172 isRetracted "false" @default.
- W2005643172 magId "2005643172" @default.