Table 6

Preoperative Exercise Testing Before Major Noncardiac Surgery

Study (Reference)n% of Patients With Abnormal TestCriteria for Abnormal Test% EventsPrediction of Cardiac EventsEventComments
% Positive Test% Negative Test
Peripheral Vascular Surgery or Abdominal Aortic Aneurysm Repair
McCabe et al., 1981 (177)31436STD, CP, or A38 (15/39)81 (13/16)91 (21/23)D, M, I, H, A
Cutler et al., 1981 (178)13039STD7 (9/130)16 (8/50)99 (79/80)D, MLess than 75% MPHR increased risk
Arous et al., 1984 (179)80817STDNR21 (19/89)NRD, M
Gardine et al., 1985 (180)8648STD11 (2/19)11 (1/9)90 (9/10)D, M
von Knorring & Lepantalo 1986 (181)10525STD, A, or CP3 (3/105)8 (2/26)99 (78/79)D, M
Leppo et al., 1987 (182)6028STD12 (7/60)25 (3/12)92 (44/48)D, MExercise test results used to refer patients for revascularization
Hanson et al., 1988 (183)7457STD3 (1/37)5 (1/19)100 (18/18)D, MArm ergometry
McPhail et al., 1988 (176)10070Less than 85% MPHR19 (19/100)24 (17/70)93 (28/30)D, M, A, FLess than 85% MPHR; p=0.04; STD; NS
Urbinati et al., 1994 (184)12123STD00/28100 (93/93)D, MCarotid endarterectomy patients. STD predicted late death
Peripheral Vascular Surgery or Major Noncardiac Surgery
Carliner et al., 1985 (185)20016STD8 (16/200)16 (5/32)93 (157/168)D, M5 METs (NS)

Numbers in parentheses that do not refer to references are number of patients divided by the total number of patients. In references 177, 179, 180, and 183, the total number of patients undergoing peripheral vascular surgery was less than the total number tested.

A indicates cardiac arrhythmia; CP, chest pain; D, death; F, failure; H, hypotension; I, myocardial ischemia; M, myocardial infarction; MET, metabolic equivalent; MPHR, maximum predicted heart rate; n, number of patients; NR, not reported; NS, not significant; and STD, exercise-induced electrocardiographic ischemia.

  • Studies with prospective collection of postoperative electrocardiogram and cardiac enzymes.