title: Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction.
abstract: OBJECTIVE
  Recent literature has questioned the efficacy of routine detailed preoperative cardiac ischemia testing and preoperative cardiac intervention before noncardiac surgical procedures.
  
  
  METHODS
  We performed a retrospective review of patients undergoing thoracotomy (n = 294) between January of 1999 and January of 2005.
  
  
  RESULTS
  The median age was 62 years. Detailed preoperative cardiac testing was performed on 184 patients (63%) and went beyond a thorough history, physical examination, and electrocardiogram to include at least one of the following: dobutamine stress echo (n = 116), nuclear stress test (n = 66), treadmill test (n = 8), and coronary angiogram (n = 40). Evidence for coronary disease was detected in 43% of tests (99/230) performed. Revascularization was performed in 10% of all patients (4/40) who underwent coronary angiography. Postoperative myocardial infarction occurred in 7 patients (2.4%) with 4 myocardial infarction-related mortalities. No significant difference was found in the incidence of myocardial infarction in patients with (n = 184) or without (n = 110) detailed preoperative cardiac testing (3.3% vs 0.9%, P = .29). Of the 4 patients (1.4%) who underwent revascularization to treat coronary lesions identified during prethoracotomy workup, 2 had a myocardial infarction, 1 of which was caused by thrombosis of a coronary stent. In the subset of patients who underwent lobectomy (n = 149), detailed cardiac testing was performed on 107 patients (72%). The incidence of myocardial infarction was similar in tested and untested patients (2.8% vs 2.4% respectively, P = 1.0).
  
  
  CONCLUSIONS
  Selective use of detailed preoperative cardiac testing refines risk stratification and identifies patients for corrective cardiac interventions; however, it did not prove fully protective against myocardial infarction after thoracotomy in our study.
authors.affiliation: Michael E. DeBakey Veterans Affairs Hospital, Houston, Tex 77030, USA.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: Jaroszewski
authors.forename: Joseph
authors.initials: J
authors.lastname: Huh
authors.forename: Danny
authors.initials: D
authors.lastname: Chu
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Riffel
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.forename: Xing Li
authors.initials: XL
authors.lastname: Wang
authors.forename: Faisal
authors.initials: F
authors.lastname: Bakaeen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods