Electrocardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery

Background: 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 compar ed with clinical parameters and resting electrocardiography. Methods: A total of 204 patients at intermediate risk for cardiac complicat ions prospectively underwent exercise electrocardiography before noncardiac surgery. Of these, 185 were included in the final evaluation. All patients 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, unstab le angina pectoris, congestive heart failure, and ventricular tachyarrhythm ia. Potential risk factors for an adverse event were identified by univaria te and multivariate logistic regression analysis. Results: Perioperative cardiac events were observed in 16 patients. There w ere 6 cases of myocardial infarction and 10 cases of myocardial cell injury . The multivariate correlates of adverse cardiac events were definite coron ary 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), r educed 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 electroc ardiogram (odds ratio, 5.2; 95% CI, 1.5-18.5; P = 0.01). A combination of c linical variables and exercise electrocardiography improved preoperative ri sk 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.