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Preoperative stress testing: new guidelines.

Stewart J Lustik1, James P Eichelberger, Ashwani K Chhibber

  • 1Department of Anesthesiology, Strong Medical Hospital, University of Rochester Medical Center, Box 604, 601 Elmwood Avenue, Rochester, NY 14642, USA. stewart_lustik@URMC.Rochester.edu

Journal of Clinical Anesthesia
|September 5, 2002
PubMed
Summary
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Preoperative cardiac stress testing before noncardiac surgery lacks proven outcome benefits. Current treatments like beta-blockade reduce risks, diminishing the value of such screening procedures.

Area of Science:

  • Cardiology
  • Perioperative Medicine
  • Cardiac Surgery

Background:

  • Current literature lacks controlled trials demonstrating outcome benefits of preoperative cardiac stress testing for noncardiac surgery.
  • Perioperative beta-blockade effectively reduces morbidity and mortality, potentially negating benefits of stress testing.
  • Interventions like percutaneous coronary intervention and coronary artery bypass graft have unproven perioperative benefits or risks that may outweigh surgical risks.

Purpose of the Study:

  • To evaluate the utility of preoperative cardiac stress testing as a screening procedure before noncardiac surgery.
  • To determine if cardiac testing and interventions offer a demonstrable outcome benefit in the context of noncardiac surgery.

Main Methods:

  • Review of existing literature on controlled trials for preoperative cardiac stress testing.

Related Experiment Videos

  • Analysis of the impact of perioperative beta-blockade on patient outcomes.
  • Assessment of the perioperative benefits and risks of percutaneous coronary intervention and coronary artery bypass graft.

    • Main Results:

    • No well-controlled trials demonstrate an outcome benefit for using stress testing as a screening procedure before noncardiac surgery.
    • Perioperative beta-blockade significantly decreases morbidity and mortality, reducing the potential benefit of stress testing.
    • The risks associated with coronary artery bypass graft surgery often offset the risks of noncardiac surgery, and preoperative percutaneous coronary intervention has unproven perioperative benefits.

    Conclusions:

    • The use of preoperative cardiac testing and procedures should be restricted to patients with symptoms or cardiac findings warranting evaluation, irrespective of upcoming surgery.
    • Outcome benefits from cardiac testing and procedures before noncardiac surgery require demonstration in properly designed trials.
    • Current evidence does not support routine cardiac screening before noncardiac surgery outside of specific symptomatic indications.