Electrocardiographic Exercise Stress Testing for Cardiac Risk Assessment in Patients Undergoing Noncardiac Surgery

Albrecht Gauss, Hans-Jörg Röhm, Andreas Schäuffelen, Thomas Vogel, Ulrich Mohl, Andreas Straehle, Rainer Meierhenrich, Michael Georgieff, Gerald Steinbach, Wolfram Schütz
2001 Anesthesiology  
The value of exercise electrocardiography in the prediction of perioperative cardiac risk has yet to be defined. This study was performed to determine the predictive value of exercise electrocardiography as compared with clinical parameters and resting electrocardiography. Methods: A total of 204 patients at intermediate risk for cardiac complications prospectively underwent exercise electrocardiography before noncardiac surgery. Of these, 185 were included in the final evaluation. All patients
more » ... underwent follow-up evaluation postoperatively by Holter monitoring for 2 days, daily 12-lead electrocardiogram, and creatine kinase, creatine kinase MB, and troponin-T measurements for 5 days. Cardiac events were defined as cardiac death, myocardial infarction, minor myocardial cell injury, unstable angina pectoris, congestive heart failure, and ventricular tachyarrhythmia. Potential risk factors for an adverse event were identified by univariate and multivariate logistic regression analysis. Results: Perioperative cardiac events were observed in 16 patients. There were 6 cases of myocardial infarction and 10 cases of myocardial cell injury. The multivariate correlates of adverse cardiac events were definite coronary artery disease (odds ratio, 8.8; 95% confidence interval [CI], 1.1-73.1; P ‫؍‬ 0.04), major surgery (odds ratio, 4.7; 95% CI, 1.3-16.3; P ‫؍‬ 0.02), reduced left ventricular performance (odds ratio, 2.0; 95% CI, 1.1-3.8; P ‫؍‬ 0.03), and ST-segment depression of 0.1 mV or more in the exercise electrocardiogram (odds ratio, 5.2; 95% CI, 1.5-18.5; P ‫؍‬ 0.01). A combination of clinical variables and exercise electrocardiography improved preoperative risk stratification. Conclusions: This prospective study shows that a ST-segment depression of 0.1 mV or more in the exercise electrocardiogram is an independent predictor of perioperative cardiac complications. . Address electronic mail to: albrecht.gauss@medizin.uni-ulm. de. Individual article reprints may be purchased through the Journal Web site, www.anesthesiology.org. Anesthesiology, V 94, No 1, Jan 2001 EXERCISE ECG FOR CARDIAC RISK ASSESSMENT Anesthesiology, V 94, No 1, Jan 2001 Downloaded From: http://anesthesiology.pubs.asahq.org/pdfaccess.ashx?url=/data/journals/jasa/931235/ on 08/15/2017 * Maximal achieved heart rate less than 100 beats/min during exercise. † Inability to achieve 85% of the predicted maximal heart rate during exercise. PMHR ϭ predicted maximal heart rate. 42 GAUSS ET AL.
doi:10.1097/00000542-200101000-00011 pmid:11135720 fatcat:2fqqj5hohbettmsuddilz75tla