unstable angina, 2 had myocardial infarction and 1 had cardiac death. A$fth patient in group 3 had an abbreviated surgical procedure because of intraoperative &hernia. Of the remaining 19 patients who did not have surgery, 7 were in group 1, 3 were in group 2 and 9 were in group 3. Two patients in group 3 had cardiac events within 1 month of dobutamine stress echocardiography. A third patient with multivessel coronary artery disease and extensive stress-induced wall motion abnormalities had sudden death. Of the 10 patients in groups I and 2 who did not undergo surgery, 1 had noncardiac death, and 1 patient with coronary disease limited to a diagonal vessel and with a 9 cm abdominal aortic aneurysm had sudden death of undetermined etiology (Table II). Eighteen of 24 patients (75%) with previous myocardial infarction were in group 3. All 6 patients with previous myocardial infarction who had cardiac events were in Group III. Twelve of the 19 patients in group 3 who underwent surgery also underwent coronary angiography. Significant coronary disease was found in 11 of these patients. Coronary angiography was performed in 7 of the 9patients in group 3 who did not undergo surgery. Significant coronary artery disease was found in 6 of these patients, and 4 underwent either coronary artery bypass grafting or coronary angioplasty.

In this retrospective study, stress-induced wall motion abnormalities during dobutamine infusion identified a group that had a 2 1% risk of cardiac events during noncardiac surgery. Patients who developed wall motion abnormalities during dobutamine infusion were at risk even if surgery was not performed. Significant coronary artery disease was found in the overwhelming majority of pa-

Hematocrit Angioplasty

Fluctuations

After

c

TABLE II Cardiac Outcome After Dobutamine Stress

tients who had coronary angiography and stress-induced wall motion abnormalities. This preliminary study demonstrates the potential utility of dobutamine stress echocardiography for predicting the cardiac outcome of noncardiac surgery. Further studies are needed to evaluate more homogeneous patient groups and to determine the relative value of dobutamine stress echocardiography in comparison with clinical predictors.

1. Berthe C, Pierard LA, Hiernaux M, Trotteur G, Lempereur P, Carl& J, Kulbertus HE. Predicting the extent and location of coronary artery disease in acute myccardial infarction by echocardiography during dobutamine infusion, Am J Cardiol 1986;58:1167-1172. 2. Sawada SG, Segar DS, Ryan T, Brown SE, Dohan AM, Williams R, Fineberg NS, Armstrong WF, Feigenbaum H. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circularion 1991;83:1605-1614. 3. Boucher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engi J Med 1985;312:389-394. 4. Leppo J, Plaja J, Gionet M, Tumolo J, Paraskos JA, Cutler BS. Noninvasive evaluation of cardiac risk before elective vascular surgery. J Am Coil Cardiol 1987;9:269-276. 5. Eagle KA, Coley CM, Newell JB, Brewster DC, Darling RC, Strauss HW, Guiney TE, Boucher CA. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989;110:859-866.

Percutaneous

Transluminal

Coronary

Eric S. Roccario, MD, Marc J. Schweiger, MD, Steven S. Whitfield, MD, William Stikley, PhD, Thomas Weil, MD, Anthony Urbano, MD, and Mark POrWay, MD decrease in hematocrit has been reported 12 hours after percutaneous transluminal coronary angioplasty (PTCA); however, the etiology and clinical significance are uncertain. l Significant blood loss is potentially dangerous in patients with tenuous coronary perfusion. This study was undertaken to determine

A

From the Cardiology Division, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, Massachusetts 01199; and Tufts University School of Medicine, Boston, Massachusetts. Manuscript received March 21,1991; revised manuscript received and accepted June 20,199l.

the degree and duration of hematocrit change and the incidence of transfusion after PTCA. One-hundred thirty consecutive patients (88 men, 42 women, aged 29 to 82 years) referred for elective PTCA over a 3-month period were prospectively analyzed. Patients who had received thrombolytic therapy were excluded. PTCA wasperformed as described2 with the Judkin’s approach. introducers were placed into both the arterial and venous systems.All patients were hydrated (before, during and 24 hours after the procedure) with 2 to 4 liters of normal saline. AdminBRIEF REPORTS 977

TABLE I Hematocrit Before and After Coronary the Two Groups Studied Day 0 Group

I

Group

II

Total *Significant

38.8 38.9 38.9

Day 1 f 4.2% k 4.3% f 4.3%

hematocrit

decrease

35.0 33.9 34.5

Angioplasty

in

Day 2 f 4.2%* r 3.6%* ?I 3.9%*

from days 0 to 1 in groups

36.1 -

i 4.0%t

I and II; total p value