Assessment of operative risk with electrocardiographic exercise testing in patients with peripheral vascular disease

Peri‐operative silent myocardial ischaemia and long‐term adverse outcomes in non‐cardiac surgical patients*

“…The association between silent myocardial ischaemia and postoperative complications after non‐cardiac surgery has been the subject of considerable interest for over 10 years [1–5]. Silent myocardial ischaemia may be detected in a number of ways including dipyridamole thallium scanning [6, 7], exercise electrocardiography (ECG) [8, 9] and ambulatory ECG (Holter monitoring) [10–12]. Ambulatory ECG compares favourably with these other modes [13–15] and is simple to use and relatively cheap.…”

Anaesthetic Assessment and Management of Cardiac Patients for Non‐cardiac Surgery Part I: Assessment

“…There are also problems in interpreting this test in patients with an abnormal baseline ECG. Despite this Cutler found this test useful in predicting outcome 47 …”

Detection of perioperative myocardial ischaemia

“…Preoperative exercise testing might be expected to be of greater value than standard ECG recording, and this has been assessed in several studies (table I). Cutler and colleagues studied 100 patients scheduled to undergo peripheral vascular surgery [22], and found that, of 73 patients who had a normal resting preoperative ECG, 14 developed an ischaemic ECG on exercise. Of the 48 patients who subsequently underwent surgery, six developed postoperative MI, Dipyridamole echocardiography Dobutamine echocardiography Transocsophageal echocardiography…”

“…Cutler [22] Lette [59] Leppo [57] Younis [130] McEnroe [69] Levinson [63] Mangano [74] Lette [61] Reifsnyder [94] Eagle [29] Eagle [28] Strawn [113] Tischler [114] Lalka [56] Smith [111] Leung [62] London [66] Watters [126] Year 197719781991199119911991199319911991perioperative Year 198519911991199119911991 Type of surgery undergoing elective major non-cardiac surgery, but did not find it to be a predictor of postoperative outcome. It would seem from these studies that the exercise ECG is of limited value as a routine screening procedure for identifying at-risk patients, but that it may be of value for subgroups at greater risk of CAD, such as patients undergoing vascular surgery.…”