Stress testing can help resolve diagnostic uncertainty in surgical patients, such as determining whether individuals with chest discomfort and vascular risk factors have undiagnosed coronary artery disease. It can also help identify patients at elevated risk for cardiac complications after major vascular surgery. Nonetheless, asymptomatic individuals with good functional capacity have a very low risk of cardiac complications after low-to-intermediate non-cardiac surgery. Stress testing in such individuals is not useful for delineating expected perioperative risk and guiding clinical care.

Conditions: preoperative(pre-op) assessment, asymptomatic patients, low to intermediate-risk non-cardiac surgery

Diagnostic Tests: cardiac stress testing, stress ecg, graded stress test (GXT), exercise stress test (EST, stress imaging, stress nuclear, stress MIBI, stress echocardiography

Sources

• Etchells E, Meade M, Tomlinson G, Cook D. Semiquantitative dipyridamole myocardial stress perfusion imaging for cardiac risk assessment before noncardiac vascular surgery: a meta-analysis. J Vasc Surg. 2002 Sep;36(3):534-40. (PubMed)
• Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Dec 9;130(24):e278-333. (PubMed)
• Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014 Sep 14;35(35):2383-431. (PubMed)
• Sgura FA, Kopecky SL, Grill JP, Gibbons RJ. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Med. 2000 Mar;108(4):334-6. (PubMed)