PREDICTIVE VALUE OF MANUAL ECG-MONITORED EXERCISE TEST BEFORE ABDOMINAL AORTIC OR PERIPHERAL VASCULAR-SURGERY

The value of manual ECG-monitored exercise test was studied in 58 pati ents (39 men and 19 women) with intermittent claudication scheduled fo r abdominal or peripheral vascular surgery. There was a high incidence of well-known risk factors (hypercholesterolemia, smoking, and hypert ension) in men and women. History of coronary artery disease (CAD) was present in 29.3% of the patients. No correlation was found between pa tients with single or multiple stenoses in lower extremity arteries (a ngiography) and CAD. Ischemic response (ECG) to manual exercise testin g was positive in 14 patients (24.1%), of whom 2 (14.3%) had major car diovascular postoperative complications. Both died of acute myocardial infarction within fourteen days. They had slow recovery (thirty to si xty minutes) of the ST segment (0.3-0.6 mV). The authors conclude that manual exercise testing might reveal serious CAD in patients with sev ere occlusive peripheral arterial disease of the lower extremities. In cases with slow recovery of ischemic response to exercise, coronary b ypass or angioplasty could be advantageous before major vascular surge ry.