title: Electrocardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery.
abstract: BACKGROUND
  The value of exercise electrocardiography in the prediction of perioperative cardiac risk has yet to be defined. This study was performed to determine the predictive value of exercise electrocardiography as compared with clinical parameters and resting electrocardiography.
  
  
  METHODS
  A total of 204 patients at intermediate risk for cardiac complications prospectively underwent exercise electrocardiography before noncardiac surgery. Of these, 185 were included in the final evaluation. All patients underwent follow-up evaluation postoperatively by Holter monitoring for 2 days, daily 12-lead electrocardiogram, and creatine kinase, creatine kinase MB, and troponin-T measurements for 5 days. Cardiac events were defined as cardiac death, myocardial infarction, minor myocardial cell injury, unstable angina pectoris, congestive heart failure, and ventricular tachyarrhythmia. Potential risk factors for an adverse event were identified by univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Perioperative cardiac events were observed in 16 patients. There were 6 cases of myocardial infarction and 10 cases of myocardial cell injury. The multivariate correlates of adverse cardiac events were definite coronary artery disease (odds ratio, 8.8; 95% confidence interval [CI], 1.1--73.1; P = 0.04), major surgery (odds ratio, 4.7; 95% CI, 1.3--16.3; P = 0.02), reduced left ventricular performance (odds ratio, 2.0; 95% CI, 1.1--3.8; P = 0.03), and ST-segment depression of 0.1 mV or more in the exercise electrocardiogram (odds ratio, 5.2; 95% CI, 1.5--18.5; P = 0.01). A combination of clinical variables and exercise electrocardiography improved preoperative risk stratification.
  
  
  CONCLUSIONS
  This prospective study shows that a ST-segment depression of 0.1 mV or more in the exercise electrocardiogram is an independent predictor of perioperative cardiac complications.
authors.affiliation: Department of Anesthesiology, Universit of Ulm, Germany. albrecht.gauss@medizin.uni-ulm.de
authors.forename: A
authors.initials: A
authors.lastname: Gauss
authors.forename: H J
authors.initials: HJ
authors.lastname: Röhm
authors.forename: A
authors.initials: A
authors.lastname: Schäuffelen
authors.forename: T
authors.initials: T
authors.lastname: Vogel
authors.forename: U
authors.initials: U
authors.lastname: Mohl
authors.forename: A
authors.initials: A
authors.lastname: Straehle
authors.forename: R
authors.initials: R
authors.lastname: Meierhenrich
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
authors.forename: G
authors.initials: G
authors.lastname: Steinbach
authors.forename: W
authors.initials: W
authors.lastname: Schütz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T