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EAGLE ET AL., PERIOPERATIVE CARDIOVASCULAR EVALUATION FOR NONCARDIAC SURGERY UPDATE
http://www.acc.org/clinical/guidelines/perio/update/periupdate_index.htm

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

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New Table 6. Preoperative Exercise Testing Before Major Noncardiac Surgery


Author

n

Abnormal
Test (%)

Criteria for Abnormal Test

Events

Patients With
Predictive Value

Event

Comments

Positive Test Negative Test

Peripheral vascular surgery or abdominal aortic aneurysm repair

McCabe 1981 (106)

314

36

STD, CP, or A

38% (15/39)

81% (13/16)

91% (21/23)

D,M,I,H,A

x

Cutler 1981 (107)

130

39

STD

7% (9/130)

16% (8/50)

99% (79/80)

D,M

Less than 75% MPHR increased risk

Arous 1984 (108)

808

17

STD

NR

21% (19/89)

NR

D,M

x

Gardine 1985 (109)

86

48

STD

11% (2/19)

11% (1/9)

90% (9/10)

D,M

x

von Knorring 1986 (110)

105

25

STD, A, or CP

3% (3/105)

8% (2/26)

99% (78/79)

D,M

x

Kopecky 1986 (116)

114

57

Less than 400 kpm

7% (8/110)

13% (8/63)

100% (47/47)

D,M

x

Leppo* 1987 (111)

60

28

STD

12% (7/60)

25% (3/12)

92% (44/48)

D,M

Exercise test results used to refer patients for revascularization

Hanson 1988 (112)

74

57

STD

3% (1/37)

5% (1/19)

100% (18/18)

D,M

Arm ergometry

McPhail* 1988 (113)

100

70

Less than 85% MPHR

19% (19/100)

24% (17/70)

93% (28/30)

D,M,A,F

Less than 85% MPHR; p=0.04; STD; NS

Urbinati 1994 (117)

121

23

STD

0

0/28

100% (93/93)

D,M

Carotid endarterectomy patients. STD predicted late death.

Peripheral vascular surgery or major noncardiac surgery

Carliner 1985 (114)

200

16

STD

16% (32/200)

16% (5/32)

93% (157/168)

D,M

5 METs (NS)

A indicates cardiac arrhythmia; CP, chest pain; D, death; F, failure; H, hypotension; I, myocardial ischemia; M, myocardial infarction; MET, metabolic equivalent; MPHR, maximum predicted heart rate; NR, not reported; NS, not significant; STD indicates exercise-induced electrocardiographic ischemia.

*Studies with prospective collection of postoperative electrocardiogram and cardiac enzymes.

In references 106, 108, 109, 112, and 116, the total number of patients undergoing peripheral vascular surgery was less than the total number tested.

 

Copyright © 2002 by the American College of Cardiology and American Heart Association, Inc.

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