Failure of bicycle exercise electrocardiograms to predict major post-operative cardiac complications in patients undergoing abdominal aortic surgery.
To determine if exercise electrocardiograms (EECGs) are justified in routine pre-operative screening for cardiac disease, we performed a prospective study on 77 consecutive patients scheduled for infrarenal aortic reconstructive surgery. All patients had EECGs performed 1-12 days prior to elective surgery. In addition to routine clinical assessment of cardiac disease, all patients were allocated a Goldman risk score. Four patients developed major post-operative cardiac complications of whom one patient died. EECG was not a significant predictor of outcome, as 48.6% of all EECGs were inadequate due to non-completion of the exercise protocol. Significant pre-operative predictors of outcome were a history of angina (p less than 0.01), myocardial infarction (p less than 0.001), congestive cardiac failure (p less than 0.0001), or a Goldman score of greater than 14 (p less than 0.05). By multivariate analysis of the pre-operative risk factors a history of congestive cardiac failure was found to be the most significant independent predictor of post-operative cardiac complications.
Joyce
W P
WP
Department of Vascular Surgery and Cardiology, Wellesley Hospital, Toronto, Ontario, Canada.
Ameli
F M
FM
McEwan
P
P
Provan
J L
JL
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012307:Risk Factors