Perioperative medicine & outcomes
Diagnostic and prognostic value of cardiac stress testing before major noncardiac surgery—A cohort study
Authors' conclusion
Cardiac stress testing before noncardiac, nonophthalmologic surgery does not improve predictions of either perioperative mortality or myocardial infarction.
Study context
- Population
- Patients considering noncardiac, nonophthalmologic surgery seen at a preoperative risk assessment and optimization clinic in a large health system, 2008–2018visits without existing coronary artery disease (CAD)
- Participants
- 136,935 patients
- Exposure
- Risk models with vs without preoperative stress test results
Methodological detailsreferral-bias-adjusted test characteristics (Begg and Greenes method), multiply-imputed logistic regression
- Referral-bias-adjusted test characteristics (Begg and Greenes method)
- Multiply-imputed logistic regression
Main finding
As reported in the abstract
Likely new CAD diagnoses identified by decision to obtain preoperative stress testing
around 4.0%
Stress testing increased likelihood of CAD (likelihood ratio)
1.31
Patients for whom stress testing should not change decision to proceed to angiography
over 99%
Observational data: associations, not effects.
Further findings
Prediction of perioperative myocardial infarction (MI) and 90-day mortality with reweighted models plus hemoglobin
- Reweighting the models and adding hemoglobin improved prediction of both outcomes
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →