The ischemic exercise test in patients with peripheral vascular disease. Implications for management.
We observed myocardial ischemia in 135 of 808 patients undergoing routine ECG-monitored treadmill tests before vascular reconstructive operations. Postoperative infarction incidence was 27% among 56 patients who had operations regardless of test results. When patients had a lesser procedure, such as extra-anatomic bypass, infarction incidence decreased to 17% (not statistically significant). Ten patients having staged aortocoronary and peripheral reconstruction had no myocardial infarctions postoperatively or during follow-up of up to five years. Of 37 patients asymptomatic for coronary artery disease who had normal ECGs at rest, 24% of those undergoing a standard intra-abdominal operation suffered myocardial infarctions. At present, such asymptomatic but high-risk patients can be identified only by routine ECG stress testing or coronary angiography. Patients with an ischemic response to exercise have the best chance for long-term survival through staged coronary and vascular reconstruction.
D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000175:diagnosis*; D005080:Exercise Test; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012306:Risk; D014652:Vascular Diseases / Q000601:surgery*