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Prior studies suggest that pts with diabetes mellitus (DM) have a poor prognosis after vascular surgery and do not benefit from preoperative risk stratification by clinical evaluation or dipyridamole-thallium (DT) imaging because of a high prevalence of underlying coronary artery disease. To determine the postop and late prognosis for diabetics undergoing vascular surgery and the utility of clinical evaluation and DT for stratifying risk; we studied 122 pts with DM who underwent clinical evaluation and DT prior to vascular surgery. Based on the number of clinical markers present (using a previously described clinical risk index: prior MI, angina, Q wave on ECG, age g 70 yrs, CHF); pts were classified into low (0), intermediate (1-2), and high risk (g 2 markers) for postop and late cardiac events. DT was assessed for reversible (REV) and fixed defects. There were 17 (14%) pts with postop events (4 cardiac deaths, 13 non-fatal Mls), and 23 (22%) with late events (8 cardiac deaths, 15 non-fatal Mls) on follow up which was possible in 98% of pts and was to 50 ± 5 months (75th quintile). On multivariate analysis, the only predictorfor postop event was REV (p l 0.01) in this inherently high risk cohort. Successful risk stratification for late events was achieved by clinical index. DT was not of prognostic value for late event. Download : Download high-res image (68KB) Download : Download full-size image Conclusions (1) Although diabetics are at high risk for events, dipyridamole-thallium imaging provides additional useful perioperative risk stratification. (2) The absence of clinical markers identifies a group with significantly better late cardiac event-free survival.