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J Am Coll Cardiol, 2007; 49:1763-1769, doi:10.1016/j.jacc.2006.11.052 (Published online 13 April 2007). © 2007 by the American College of Cardiology Foundation

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A Clinical Randomized Trial to Evaluate the Safety of a Noninvasive Approach in High-Risk Patients Undergoing Major Vascular Surgery

The DECREASE-V Pilot Study

Don Poldermans, MD^_*,_*, Olaf Schouten, MD, Radosav Vidakovic, MD, Jeroen J. Bax, MD, Ian R. Thomson, MD^||, Sanne E. Hoeks, MSc, Harm H.H. Feringa, MD, Martin Dunkelgrün, MD, Peter de Jaegere, MD, Alexander Maat, MD^¶, Marc R.H.M. van Sambeek, MD, Miklos D. Kertai, MD^_*, Eric Boersma, PhD for the DECREASE Study Group

^_* Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
^¶ Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
^|| Department of Anesthesiology, University of Alberta, Winnipeg, Manitoba, Canada.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Flowchart of the Study Cardiac risk factors included age over 70 years, angina pectoris, prior myocardial infarction (MI) on the basis of history or a finding of pathologic Q waves on electrocardiography, compensated congestive heart failure or a history of congestive heart failure, current treatment for diabetes mellitus, renal dysfunction (serum creatinine >160 µmol/l), and prior stroke or transient ischemic attack. Patients with >3 risk factors and extensive ischemia were randomly (1:1) assigned to coronary revascularization.

View larger version (5K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Incidence of All-Cause Death or Myocardial Infarction During 1-Year Follow-Up According to the Allocated Strategy in Patients With 3 or More Cardiac Risk Factors With Extensive Stress-Induced Ischemia Light line = best medical treatment only; dark line = best medical treatment and prophylactic revascularization.