Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction

  • D.E. J
  • J. H
  • D. C
  • et al.
Citations of this article
Mendeley users who have this article in their library.
Get full text


Objective: Recent literature has questioned the efficacy of routine detailed preoperative cardiac ischemia testing and preoperative cardiac intervention before noncardiac surgical procedures. Methods: We performed a retrospective review of patients undergoing thoracotomy (n = 294) between January of 1999 and January of 2005. Results: The median age was 62 years. Detailed preoperative cardiac testing was performed on 184 patients (63%) and went beyond a thorough history, physical examination, and electrocardiogram to include at least one of the following: dobutamine stress echo (n = 116), nuclear stress test (n = 66), treadmill test (n = 8), and coronary angiogram (n = 40). Evidence for coronary disease was detected in 43% of tests (99/230) performed. Revascularization was performed in 10% of all patients (4/40) who underwent coronary angiography. Postoperative myocardial infarction occurred in 7 patients (2.4%) with 4 myocardial infarction-related mortalities. No significant difference was found in the incidence of myocardial infarction in patients with (n = 184) or without (n = 110) detailed preoperative cardiac testing (3.3% vs 0.9%, P = .29). Of the 4 patients (1.4%) who underwent revascularization to treat coronary lesions identified during prethoracotomy workup, 2 had a myocardial infarction, 1 of which was caused by thrombosis of a coronary stent. In the subset of patients who underwent lobectomy (n = 149), detailed cardiac testing was performed on 107 patients (72%). The incidence of myocardial infarction was similar in tested and untested patients (2.8% vs 2.4% respectively, P = 1.0). Conclusion: Selective use of detailed preoperative cardiac testing refines risk stratification and identifies patients for corrective cardiac interventions; however, it did not prove fully protective against myocardial infarction after thoracotomy in our study. © 2008 The American Association for Thoracic Surgery.




D.E., J., J., H., D., C., S.C., M., A.D., R., H.S., G., & X.L., W. (2008). Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction. Journal of Thoracic and Cardiovascular Surgery, 135(3), 648–655. https://doi.org/http://dx.doi.org/10.1016/j.jtcvs.2007.09.021

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free