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J Thorac Cardiovasc Surg 2008;135:648-655
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Utility of detailed preoperative cardiac testing and incidence of post-thoracotomy myocardial infarction

^a Michael E. DeBakey Veterans Affairs Hospital, Houston, Tex
^b Baylor College of Medicine, Houston, Tex
^c Mayo Clinic, Phoenix, Ariz

Received for publication June 19, 2007; revisions received August 20, 2007; accepted for publication September 24, 2007.

^_* Address for reprints: Faisal Bakaeen, MD, Baylor College of Medicine, Department of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. OCL (112), Houston, TX 77030. (Email: fbakaeen{at}bcm.edu).

Objective: Recent literature has questioned the efficacy of routine detailed preoperative cardiac ischemia testing and preoperative cardiac intervention before noncardiac surgical procedures.

Methods: We performed a retrospective review of patients undergoing thoracotomy (n = 294) between January of 1999 and January of 2005.

Results: The median age was 62 years. Detailed preoperative cardiac testing was performed on 184 patients (63%) and went beyond a thorough history, physical examination, and electrocardiogram to include at least one of the following: dobutamine stress echo (n = 116), nuclear stress test (n = 66), treadmill test (n = 8), and coronary angiogram (n = 40). Evidence for coronary disease was detected in 43% of tests (99/230) performed. Revascularization was performed in 10% of all patients (4/40) who underwent coronary angiography. Postoperative myocardial infarction occurred in 7 patients (2.4%) with 4 myocardial infarction-related mortalities. No significant difference was found in the incidence of myocardial infarction in patients with (n = 184) or without (n = 110) detailed preoperative cardiac testing (3.3% vs 0.9%, P = .29). Of the 4 patients (1.4%) who underwent revascularization to treat coronary lesions identified during prethoracotomy workup, 2 had a myocardial infarction, 1 of which was caused by thrombosis of a coronary stent. In the subset of patients who underwent lobectomy (n = 149), detailed cardiac testing was performed on 107 patients (72%). The incidence of myocardial infarction was similar in tested and untested patients (2.8% vs 2.4% respectively, P = 1.0).

Conclusion: Selective use of detailed preoperative cardiac testing refines risk stratification and identifies patients for corrective cardiac interventions; however, it did not prove fully protective against myocardial infarction after thoracotomy in our study.