Document Detail

Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction.
MedLine Citation:
PMID:  18329488     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Recent literature has questioned the efficacy of routine detailed preoperative cardiac ischemia testing and preoperative cardiac intervention before noncardiac surgical procedures. METHODS: We performed a retrospective review of patients undergoing thoracotomy (n = 294) between January of 1999 and January of 2005. RESULTS: The median age was 62 years. Detailed preoperative cardiac testing was performed on 184 patients (63%) and went beyond a thorough history, physical examination, and electrocardiogram to include at least one of the following: dobutamine stress echo (n = 116), nuclear stress test (n = 66), treadmill test (n = 8), and coronary angiogram (n = 40). Evidence for coronary disease was detected in 43% of tests (99/230) performed. Revascularization was performed in 10% of all patients (4/40) who underwent coronary angiography. Postoperative myocardial infarction occurred in 7 patients (2.4%) with 4 myocardial infarction-related mortalities. No significant difference was found in the incidence of myocardial infarction in patients with (n = 184) or without (n = 110) detailed preoperative cardiac testing (3.3% vs 0.9%, P = .29). Of the 4 patients (1.4%) who underwent revascularization to treat coronary lesions identified during prethoracotomy workup, 2 had a myocardial infarction, 1 of which was caused by thrombosis of a coronary stent. In the subset of patients who underwent lobectomy (n = 149), detailed cardiac testing was performed on 107 patients (72%). The incidence of myocardial infarction was similar in tested and untested patients (2.8% vs 2.4% respectively, P = 1.0). CONCLUSION: Selective use of detailed preoperative cardiac testing refines risk stratification and identifies patients for corrective cardiac interventions; however, it did not prove fully protective against myocardial infarction after thoracotomy in our study.
Dawn E Jaroszewski; Joseph Huh; Danny Chu; S Chris Malaisrie; Anthony D Riffel; Howard S Gordon; Xing Li Wang; Faisal Bakaeen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  135     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-10     Completed Date:  2008-04-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  648-55     Citation Subset:  AIM; IM    
Michael E. DeBakey Veterans Affairs Hospital, Houston, Tex 77030, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / methods
Cohort Studies
Coronary Angiography / methods
Echocardiography, Stress / methods
Follow-Up Studies
Heart Catheterization / methods
Heart Function Tests
Lung Neoplasms / mortality,  pathology,  surgery*
Middle Aged
Multivariate Analysis
Myocardial Infarction / diagnosis*,  epidemiology*,  therapy
Myocardial Ischemia / diagnosis,  epidemiology,  therapy
Neoplasm Staging
Postoperative Complications / prevention & control
Preoperative Care / methods*
Retrospective Studies
Risk Assessment
Sex Distribution
Survival Analysis
Thoracotomy / adverse effects*,  methods

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