|Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction.|
|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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|Type: Journal Article|
|Title: The Journal of thoracic and cardiovascular surgery Volume: 135 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2008 Mar|
|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|
|Languages: eng Pagination: 648-55 Citation Subset: AIM; IM|
|Michael E. DeBakey Veterans Affairs Hospital, Houston, Tex 77030, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / methods
Coronary Angiography / methods
Echocardiography, Stress / methods
Heart Catheterization / methods
Heart Function Tests
Lung Neoplasms / mortality, pathology, surgery*
Myocardial Infarction / diagnosis*, epidemiology*, therapy
Myocardial Ischemia / diagnosis, epidemiology, therapy
Postoperative Complications / prevention & control
Preoperative Care / methods*
Thoracotomy / adverse effects*, methods
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