Implementing ACC/AHA guidelines for the preoperative management of patients with coronary artery disease scheduled for noncardiac surgery: effect on perioperative outcome.
OBJECTIVE
To review the new consensus guidelines for cardiac testing for the patient with cardiac disease scheduled for elective, noncardiac surgery, and their impact on cardiac functional testing.


METHODS
Retrospective chart review study.


METHODS
Tertiary care medical center.


METHODS
181 patients scheduled for elective, major surgery who met American College of Cardiology/American Heart Association (ACC/AHA) criteria for a preoperative stress test.


METHODS
A variety of tests were ordered, including treadmill stress testing, persantine-thallium imaging, dobutamine echocardiography, and exercise stress echocardiography.


METHODS
The numbers of and outcome of the stress tests and the cardiac outcome of the patients who underwent cardiac testing and surgery were recorded.


RESULTS
Abnormal tests occurred in 27 patients. Two patients declined treatment, eight patients had primary medical management, and the remainder (17) had cardiac catheterization. Results included no lesion (2 patients), angioplasty (4 patients), angioplasty plus stenting (1 patient), coronary artery bypass grafting (CABG) (4 patients), and delineated lesions treated with medical optimization (6 patients). One patient had CABG and declined further surgery. One patient had myocardial infarction 6 months after surgery that was treated by medical management after cardiac catheterization. The other 23 patients had surgery without cardiac complication within 1 year of surgery. Only 15% (27/180) of the patients with indications for a stress test had a positive result. Even fewer patients had any alteration of the perioperative period. Despite this finding, cardiac morbidity was very low.


CONCLUSIONS
The guidelines for stress test may be over-sensitive, and further prospective clinical studies are indicated.
Farid
Ibrahim
I
Department of General Anesthesiology, The Cleveland Clinic Foundation, OH 44195, USA.
Litaker
David
D
Tetzlaff
John E
JE
D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D025401:Echocardiography, Stress; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005080:Exercise Test; D006321:Heart / Q000000981:diagnostic imaging; D006334:Heart Function Tests; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed