This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beattie, W. S. Articles by Karkouti, K. Search for Related Content PubMed Articles by Beattie, W. S. Articles by Karkouti, K.

AN EVALUATION OF PRE-OPERATIVE CORONARY ANGIOGRAPHY IN NON-CARDIAC SURGERY

Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario M5G 2C4

INTRODUCTION: The prevailing consensus among experts is that moderate to high risk patients with positive non-invasive testing should have angiography and re-vascularized, if possible, prior to elective non-cardiac surgery¹. This belief is held even though there are no clinical trials to support it. The present study was conducted to assess if preoperative angiography, conducted in patients at moderate risk AND with positive pre-operative stress tests, leads to reduced morbidity.

METHODS: The meta-analysis used publications assessing the utility of nuclear scintigraphy and stress echocardiography. We searched the electronic databases, computerized bibliographies; hand searched of relevant journals, and corresponded with authors. In the MEDLINE search we used the MeSH headings: dipyridamole, thallium, sestamibi, dobutamine, stress echocardiography. Articles were reviewed for selection criteria, angiography, myocardial infarction and death. Analysis used Revman 4.2

RESULTS: Our search identified 46 studies encompassing 7376 patients. 30 studies (4369 patients) employed selection criteria, which allowed for coronary angiography. The test results and management of the results are seen in figure 1. 29% of patients had a positive stress test. 694 (15%) of patients underwent angiography. 216 (5%) had revascularization; 478 patients were not amenable to re-vascularization. Cardiac events in patients who had a positive stress and no angiography were 12.1% and angiography 6.7%; RR (0.55, 95% CI 0.41,.75). Re-vascularized patients had 12 cardiac events (5%) RR (.48, 95% CI .28, .78) most events occurred during investigation or revascularization.

CONCLUSION: The practice of angiography in patients with a positive stress test led to a management strategy that reduced the cardiac event rate. This practice should be evaluated in a well-designed clinical trial.

REFERENCE:

1 Goldman L., Evidence Based Perioperative Risk Reduction Am. J. Med 2003; 114: 763[Medline]

This article has been cited by other articles:

				W. S. Beattie Evidence-based perioperative risk reduction Can J Anesth, June 1, 2005; 52(suppl_1): R5 - R5. [Full Text] [PDF]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Beattie, W. S. Articles by Karkouti, K. Search for Related Content PubMed Articles by Beattie, W. S. Articles by Karkouti, K.