Pre-operative non-invasive cardiac stress testing improves one-year survival and reduces hospital stay in patients undergoing intermediate to high-risk non-cardiac surgery, a large retrospective study finds.
Of almost 24,000 patients who underwent stress testing within 180 days before having elective non-cardiac procedures, those who had intermediate-to-high-risk procedures had significantly improved one-year survival (P=0.03) than those who did not receive pre-operative stress testing.
Hospital mortality and hospital stay was also reduced in patients who underwent stress testing (difference -0.24 days) and was most apparent in those with three or more clinical risk factors who were at high risk for cardiac complications.
Conversely, stress testing was associated with only minor benefits among intermediate-risk patients with one or two clinical risk factors for cardiac complications, and testing was associated with harm in low-risk individuals.
“Our results do not support the use of preoperative stressing in low-risk patients and suggest that pre-operative stress testing should be reserved for patients with clinical risk-factors for cardiac complications,” the study authors wrote in the BMJ. They noted that because testing was associated with only a small benefit in intermediate-risk patients, the small magnitude of this effect means routine preoperative stress testing is ‘not justified’ in intermediate-risk patients.
“Our results do, however, support the safety and potential benefits of selective testing in intermediate patients,” they said.
They noted that their findings agree with guidelines by the American College of Cardiology and American Heart Association that emphasise stress testing in individuals who are undergoing intermediate-to high-risk surgery.
However, they concluded that future research is needed to determine whether stress testing provides additional prognostic information in specific subgroups of intermediate-risk patients, such as those with poor functional status or with previous history of ischaemic heart disease.
BMJ 2010;340:b5401
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