Expert opinion regarding indications for coronary angiography before noncardiac surgery.
Whether to perform coronary angiography on the basis of preoperative noninvasive cardiac testing remains a difficult decision. We hypothesized that there are noninvasive test results for which experts have general agreement about the indication for preoperative coronary angiography. We asked 30 experts (24 in specific diagnostic tests and six in clinical cardiology) to comment on statements regarding hypothetical noninvasive test results. There was agreement that catheterization should be performed for (1) exercise electrocardiographic ischemia with a blood pressure drop > 10 mm Hg, (2) stress perfusion scan reversibility in one half or more of single-photon emission computed tomographic slices, and (3) stress echo ischemia in more than five segments, two or more coronary artery zones, or four left anterior descending coronary artery segments. Therefore coronary angiography should be performed for results of noninvasive tests that indicate large zones of myocardial ischemia and not for limited ischemia or test abnormalities without other significant findings.
Cohen
M C
MC
Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Eagle
K A
KA
D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003697:Delphi Technique; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D015899:Tomography, Emission-Computed, Single-Photon