Preoperative stress testing only beneficial for higher risk patients

January 01, 0001

Preoperative stress testing only beneficial for higher risk patients

Family physicians are often called upon to evaluate and clear patients for surgery, with a central question being whether or not to perform a stress test. These Canadian researchers examined the association between non-invasive cardiac stress testing prior to elective non-cardiac surgery with survival and hospital stay. They did this via a population based retrospective cohort study looking at a ten year period. They used patients aged 40 years or older undergoing elective non-cardiac surgical procedures.

The researchers found: "Of the 271,082 patients in the entire cohort, 23,991 (8.9%) underwent stress testing. After propensity score methods were used to reduce important differences between patients who did or did not undergo preoperative stress testing and assemble a matched cohort (n=46 120), testing was associated with improved one year survival (HR 0.93) and reduced mean hospital stay (difference -0.24 days). In an analysis of subgroups defined by Revised Cardiac Risk Index (RCRI) class, testing was associated with harm in low risk patients (RCRI 0 points, HR 1.35), but with benefit in patients who were at intermediate risk (RCRI 1-2 points, HR 0.92) or high risk (RCRI 3-6 points:, HR 0.80)."

They concluded: "Preoperative non-invasive cardiac stress testing is associated with improved one year survival and length of hospital stay in patients undergoing elective intermediate to high risk non-cardiac surgery. These benefits principally apply to patients with risk factors for perioperative cardiac complications."

This large study supports non-invasive cardiac stress testing preoperatively for patients at higher cardiovascular risk. However, it also suggests low risk patients shouldn’t be so tested.

For the full abstract, click here.

BMJ 340:b5526, 28 January 2010
© 2010 Wijeysundara et al.
Non-invasive cardiac stress testing before elective major non- cardiac surgery: population based cohort study. Duminda N Wijeysundera, W Scott Beattie, R Fraser Elliot, Peter C Austin, Janet E Hux, Andreas Laupacis. Correspondence to D N Wijeysundera:

Category: K. Circulatory. Keywords: cardiac stress testing, preoperative evaluation, mortality, hospital stay, Revised Cardiac risk index, population based retrospective cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 24 February 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.