Assessment of cardiac risk before nonvascular surgery

Mini K. Das, Patricia Pellikka, Douglas W. Mahoney, Veronique Lee Roger, Jae Kuen Oh, Robert B. McCully, James B. Seward

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Objective. This study evaluated the incremental value of dobutamine stress echocardiography (DSE) for assessment of cardiac risk before nonvascular surgery. Background. Limited information exists regarding the preoperative assessment of cardiac risk in patients with known or suspected coronary artery disease who are to undergo nonvascular surgery. Methods. All patients (303 men, 227 women) who underwent DSE before nonvascular surgery and did not sustain an intervening event (coronary revascularization or cardiac event) were studied. Clinical, electrocardiographic and rest and stress echocardiographic variables were evaluated to identify predictors of postoperative cardiac events. Results. Events occurred in 6% of patients: 1 cardiac death and 31 nonfatal myocardial infarctions. All of these patients had inducible ischemia on DSE (sensitivity 100%, specificity 63%). Multivariate predictors of postoperative events in patients with ischemia were history of congestive heart failure (p = 0.006; odds ratio = 4.66; confidence interval 1.55 to 14.02) and ischemic threshold less than 60% of age- predicted maximal heart rate (p = 0.0001; odds ratio 7.002; confidence interval 2.79 to 17.61). Clinical variables of Eagle's index identified 21% of patients as low, 68% as intermediate and 11% as high risk preoperatively; the postoperative event rates were 3%, 6% and 14%, respectively. Dobutamine stress echocardiography identified 60% of patients as low (no ischemia), 32% as intermediate (ischemic threshold 60% or more) and 8% as high risk (ischemic threshold < 60%); postoperative event rates were 0%, 9% and 43%, respectively. Conclusions. In this population of patients with known or suspected coronary artery disease evaluated before nonvascular surgery, DSE had incremental value over clinical, electrocardiographic and rest echocardiographic variables for identifying patients at low, intermediate and high risk for postoperative cardiac events. Ischemia occurring at less than 60% of age-predicted maximal heart rate identified patients at highest risk. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1647-1653
Number of pages7
JournalJournal of the American College of Cardiology
Volume35
Issue number6
DOIs
StatePublished - May 2000

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Stress Echocardiography
Ischemia
Coronary Artery Disease
Heart Rate
Odds Ratio
Confidence Intervals
Eagles
Heart Failure
Myocardial Infarction
Sensitivity and Specificity
Population

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Assessment of cardiac risk before nonvascular surgery. / Das, Mini K.; Pellikka, Patricia; Mahoney, Douglas W.; Roger, Veronique Lee; Oh, Jae Kuen; McCully, Robert B.; Seward, James B.

In: Journal of the American College of Cardiology, Vol. 35, No. 6, 05.2000, p. 1647-1653.

Research output: Contribution to journalArticle

Das, Mini K. ; Pellikka, Patricia ; Mahoney, Douglas W. ; Roger, Veronique Lee ; Oh, Jae Kuen ; McCully, Robert B. ; Seward, James B. / Assessment of cardiac risk before nonvascular surgery. In: Journal of the American College of Cardiology. 2000 ; Vol. 35, No. 6. pp. 1647-1653.
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title = "Assessment of cardiac risk before nonvascular surgery",
abstract = "Objective. This study evaluated the incremental value of dobutamine stress echocardiography (DSE) for assessment of cardiac risk before nonvascular surgery. Background. Limited information exists regarding the preoperative assessment of cardiac risk in patients with known or suspected coronary artery disease who are to undergo nonvascular surgery. Methods. All patients (303 men, 227 women) who underwent DSE before nonvascular surgery and did not sustain an intervening event (coronary revascularization or cardiac event) were studied. Clinical, electrocardiographic and rest and stress echocardiographic variables were evaluated to identify predictors of postoperative cardiac events. Results. Events occurred in 6{\%} of patients: 1 cardiac death and 31 nonfatal myocardial infarctions. All of these patients had inducible ischemia on DSE (sensitivity 100{\%}, specificity 63{\%}). Multivariate predictors of postoperative events in patients with ischemia were history of congestive heart failure (p = 0.006; odds ratio = 4.66; confidence interval 1.55 to 14.02) and ischemic threshold less than 60{\%} of age- predicted maximal heart rate (p = 0.0001; odds ratio 7.002; confidence interval 2.79 to 17.61). Clinical variables of Eagle's index identified 21{\%} of patients as low, 68{\%} as intermediate and 11{\%} as high risk preoperatively; the postoperative event rates were 3{\%}, 6{\%} and 14{\%}, respectively. Dobutamine stress echocardiography identified 60{\%} of patients as low (no ischemia), 32{\%} as intermediate (ischemic threshold 60{\%} or more) and 8{\%} as high risk (ischemic threshold < 60{\%}); postoperative event rates were 0{\%}, 9{\%} and 43{\%}, respectively. Conclusions. In this population of patients with known or suspected coronary artery disease evaluated before nonvascular surgery, DSE had incremental value over clinical, electrocardiographic and rest echocardiographic variables for identifying patients at low, intermediate and high risk for postoperative cardiac events. Ischemia occurring at less than 60{\%} of age-predicted maximal heart rate identified patients at highest risk. (C) 2000 by the American College of Cardiology.",
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AU - Das, Mini K.

AU - Pellikka, Patricia

AU - Mahoney, Douglas W.

AU - Roger, Veronique Lee

AU - Oh, Jae Kuen

AU - McCully, Robert B.

AU - Seward, James B.

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N2 - Objective. This study evaluated the incremental value of dobutamine stress echocardiography (DSE) for assessment of cardiac risk before nonvascular surgery. Background. Limited information exists regarding the preoperative assessment of cardiac risk in patients with known or suspected coronary artery disease who are to undergo nonvascular surgery. Methods. All patients (303 men, 227 women) who underwent DSE before nonvascular surgery and did not sustain an intervening event (coronary revascularization or cardiac event) were studied. Clinical, electrocardiographic and rest and stress echocardiographic variables were evaluated to identify predictors of postoperative cardiac events. Results. Events occurred in 6% of patients: 1 cardiac death and 31 nonfatal myocardial infarctions. All of these patients had inducible ischemia on DSE (sensitivity 100%, specificity 63%). Multivariate predictors of postoperative events in patients with ischemia were history of congestive heart failure (p = 0.006; odds ratio = 4.66; confidence interval 1.55 to 14.02) and ischemic threshold less than 60% of age- predicted maximal heart rate (p = 0.0001; odds ratio 7.002; confidence interval 2.79 to 17.61). Clinical variables of Eagle's index identified 21% of patients as low, 68% as intermediate and 11% as high risk preoperatively; the postoperative event rates were 3%, 6% and 14%, respectively. Dobutamine stress echocardiography identified 60% of patients as low (no ischemia), 32% as intermediate (ischemic threshold 60% or more) and 8% as high risk (ischemic threshold < 60%); postoperative event rates were 0%, 9% and 43%, respectively. Conclusions. In this population of patients with known or suspected coronary artery disease evaluated before nonvascular surgery, DSE had incremental value over clinical, electrocardiographic and rest echocardiographic variables for identifying patients at low, intermediate and high risk for postoperative cardiac events. Ischemia occurring at less than 60% of age-predicted maximal heart rate identified patients at highest risk. (C) 2000 by the American College of Cardiology.

AB - Objective. This study evaluated the incremental value of dobutamine stress echocardiography (DSE) for assessment of cardiac risk before nonvascular surgery. Background. Limited information exists regarding the preoperative assessment of cardiac risk in patients with known or suspected coronary artery disease who are to undergo nonvascular surgery. Methods. All patients (303 men, 227 women) who underwent DSE before nonvascular surgery and did not sustain an intervening event (coronary revascularization or cardiac event) were studied. Clinical, electrocardiographic and rest and stress echocardiographic variables were evaluated to identify predictors of postoperative cardiac events. Results. Events occurred in 6% of patients: 1 cardiac death and 31 nonfatal myocardial infarctions. All of these patients had inducible ischemia on DSE (sensitivity 100%, specificity 63%). Multivariate predictors of postoperative events in patients with ischemia were history of congestive heart failure (p = 0.006; odds ratio = 4.66; confidence interval 1.55 to 14.02) and ischemic threshold less than 60% of age- predicted maximal heart rate (p = 0.0001; odds ratio 7.002; confidence interval 2.79 to 17.61). Clinical variables of Eagle's index identified 21% of patients as low, 68% as intermediate and 11% as high risk preoperatively; the postoperative event rates were 3%, 6% and 14%, respectively. Dobutamine stress echocardiography identified 60% of patients as low (no ischemia), 32% as intermediate (ischemic threshold 60% or more) and 8% as high risk (ischemic threshold < 60%); postoperative event rates were 0%, 9% and 43%, respectively. Conclusions. In this population of patients with known or suspected coronary artery disease evaluated before nonvascular surgery, DSE had incremental value over clinical, electrocardiographic and rest echocardiographic variables for identifying patients at low, intermediate and high risk for postoperative cardiac events. Ischemia occurring at less than 60% of age-predicted maximal heart rate identified patients at highest risk. (C) 2000 by the American College of Cardiology.

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