title: Preoperative stress testing in high-risk vascular surgery and its association with gender.
abstract: BACKGROUND
  Despite significant improvement in anesthetic and surgical techniques, the incidence of perioperative myocardial infarction (PMI) and all-cause mortality from any cardiac event during high-risk vascular surgery (abdominal aortic or infrainguinal revascularization procedures) remains high. In addition, there are significant health care costs associated with the management of PMI.
  
  
  OBJECTIVE
  The aim of this analysis was to investigate the utility of routine preoperative myocardial stress testing prior to high-risk vascular surgery and the interventions performed based on the results of the testing. The outcome after surgery, based on sex of the patients, was also examined.
  
  
  METHODS
  A retrospective analysis was performed on consecutive adult patients who had a positive dipyridamole-thallium stress test prior to high-risk vascular surgery in a university hospital (tertiary care center) between July 2001 and August 2004. The patients' preoperative demographic characteristics, perioperative record, and postoperative course in the hospital were analyzed. Combined major adverse outcome was defined as any incidence of MI, congestive heart failure, arrhythmias, renal failure, or death.
  
  
  RESULTS
  Of a total of 503 patients, 160 had a positive stress test prior to high-risk vascular surgery (111 men, 49 women; mean [SD] age, 68 [11] and 70 [12] years, respectively). Men with a positive stress test who had either coronary intervention or perioperative β-blockade prior to surgery had a significant decrease in the incidence of combined major adverse outcomes (P = 0.02). Conversely, women did not have a significant improvement in outcome with either of the preoperative strategies. Using logistic regression, only age and conservative management in men were found to be predictors of adverse outcomes.
  
  
  CONCLUSIONS
  In this small retrospective study, men with positive stress tests had fewer adverse events with either preoperative coronary revascularization or perioperative administration of β-adrenergic blocking drugs, compared with men who received no intervention. There were no significant differences in adverse outcomes between women with positive stress tests who received either treatment compared with those who did not receive any treatment.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Management, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA. rmatyal@bidmc.harvard.edu
authors.forename: Robina
authors.initials: R
authors.lastname: Matyal
authors.forename: Feroze
authors.initials: F
authors.lastname: Mahmood
authors.forename: Kyung W
authors.initials: KW
authors.lastname: Park
authors.forename: Philip
authors.initials: P
authors.lastname: Hess
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000517:prevention & control; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D014656:Vascular Surgical Procedures / Q000401:mortality*
chemical_list: D000319:Adrenergic beta-Antagonists