Preoperative cardiac evaluation is unnecessary in most patients undergoing vascular operations

BACKGROUND: This study evaluated the impact of Goldman's index (GI), radionuclide ventriculography (RVG), and dipyridamole-thallium scintigraphy (DTS) on predicting cardiac outcome after vascular operations. METHODS: A total of 463 consecutive patients undergoing vascular operations were divided into those who had no DTS, those who had reversible ischemia by DTS, and those who had no reversible ischemia by DTS, GI, ejection fraction, wall motion abnormalities, rate of coronary angiography, and revascularization were determined for each group. RESULT: Coronary revascularization was ultimately performed in 8% of patients with no DTS, 7% of patients with no ischemia by DTS, and 9% of patients with ischemia by DTS, The GI of 6.1 in patients who died postoperatively was significantly higher than the GI of 3.6 in patients who survived (P = 0.02), RVG did not predict mortality, morbidity, or need for coronary revascularization. CONCLUSION: Clinical assessment remains a good predictor for cardiac outcome in patients undergoing vascular operations. More extensive cardiac testing should be reserved for patients with higher GI and active cardiac problems. Am J Surg. 1998;176:671-675, (C) 1998 by Excerpta Medica, Inc.