Preoperative non-invasive stress testing

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.b5401 (Published 18 January 2010) Cite this as: BMJ 2010;340:b5401
  1. Davy Cheng, professor and chair
  1. 1Department of Anesthesia and Perioperative Medicine, University of Western Ontario, LHSC-University Hospital, 339 Windermere Road, C3-172, London, ON, Canada N6A 5A5
  1. davy.cheng{at}lhsc.on.ca

    Should be reserved for patients at high risk of perioperative cardiac complications

    Stress testing is commonly used for diagnosis and risk stratification of patients with coronary artery disease. The aim of preoperative stress testing is to reduce morbidity and mortality after major non-cardiac surgery, but a positive test often results in delay of surgery and subsequent coronary or pharmacological interventions.

    In the linked retrospective cohort study (doi:10.1136/bmj.b5526), Wijeysundera and colleagues assess the effect of non-invasive cardiac stress testing before elective intermediate to high risk non-cardiac surgery on survival and hospital stay. They found that preoperative non-invasive stress testing was associated with higher rate of preoperative cardiac procedures, improved survival at one year, and reduced length of stay in hospital. This survival benefit mainly applied to patients at high risk of perioperative cardiac complications (revised cardiac risk index (RCRI) 3-6: hazard ratio 0.80, 95% confidence interval 0.67 to 0.97, number needed to treat 38). In contrast, stress testing was of only minor benefit in patients at intermediate risk (RCRI 1-2: 0.92, 0.85 to 0.99) and was associated with harm in those at low risk (RCRI 0: 1.35, 1.05 to 1.74).1

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