Transitory Myocardial Ischemia in Patients with Vascular Lower Limb Amputation Relationship with Long-Term Atherothrombotic Events

Transitory Myocardial Ischemia in Patients with Vascular Lower Limb Amputation Relationship with Long-Term Atherothrombotic Events

Author McNeill Ingham, Sheila Jean Autor UNIFESP Google Scholar
Chamlian, Therezinha Rosane Autor UNIFESP Google Scholar
Souza, Jose Marconi de Autor UNIFESP Google Scholar
Stefanini, Edson Autor UNIFESP Google Scholar
Azevedo, Rudyney Autor UNIFESP Google Scholar
Mussi, Aurelia Autor UNIFESP Google Scholar
Carvalho, Antonio Carlos Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Objective: To evaluate the prevalence of asymptomatic transitory myocardial ischemia during scintigraphy among amputees of vascular etiology as well as to ascertain correlation with atherothrombotic events during long-term follow-up.Design: A cohort, mean follow-up of 2.1 yrs study was performed in an outpatient rehabilitation clinic with 58 lower limb vascular amputees who were referred for rehabilitation, asymptomatic for coronary heart disease. Patients were evaluated for myocardial ischemia by dipyridamole scintigraphy, and occurrence of severe cardiovascular events (death, acute myocardial infarction, stroke, and peripheral ischemia with hospitalization) was assessed.Results: of the 58 patients, 26 (44.8%) had positive dipyridamole myocardial scintigraphy for transitory myocardial ischemia. During follow-up, 12 subjects (20.7%), mainly diabetic patients (83%), registered a serious cardiovascular event, with 9 of 12 events having occurred in those who had tested positive for transitory ischemia on scintigraphy (P < 0.025). There were five deaths (19.2%) in those with a positive scintigraphy and a single death (3.1%) in those with a negative dipyridamole test, although the Kaplan-Meier survival curve and Cox regression were not significant (P = 0.09 and 0.1, respectively).Conclusions: We found that 44.8% of patients with vascular lower limb amputation, asymptomatic for coronary disease, tested positive on myocardial scintigraphy for transitory myocardial ischemia. in a mean follow-up of 2.1 yrs, there was 10.3% of atherothrombotic events/year, with a higher death toll in those patients with positive scintigraphy.
Keywords Amputees
Atherosclerosis
Acute Coronary Syndromes
Myocardial Perfusion Scintigraphy
Peripheral Arterial Disease
Language English
Date 2009-02-01
Published in American Journal of Physical Medicine & Rehabilitation. Philadelphia: Lippincott Williams & Wilkins, v. 88, n. 2, p. 114-118, 2009.
ISSN 0894-9115 (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 114-118
Origin http://dx.doi.org/10.1097/PHM.0b013e3181951c98
Access rights Closed access
Type Article
Web of Science ID WOS:000262739900005
URI http://repositorio.unifesp.br/handle/11600/31305

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