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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)
(Printer-friendly
version)
New
Table 6. Preoperative
Exercise Testing Before Major Noncardiac Surgery
|
Author
|
n
|
Patients
With Abnormal
Test
(%)
|
Criteria
for Abnormal Test
|
Events
|
Predictive
Value
Positive Negative
Test Test
|
Event
|
Comments
|
|
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
|
32%
(16/200)
|
16%
(5/32)
|
93%
(157/168)
|
D,M
|
5
METs (NS)
|
STD
indicates exercise-induced electrocardiographic ischemia;
CP, chest pain; A, cardiac arrhythmia; D, death; M,
myocardial infarction; I, myocardial ischemia; H, hypotension;
MPHR, maximum predicted heart rate; NR, not reported;
F, failure; NS, not significant; MET, metabolic equivalent.
*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.
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