To summarize available evidence on preoperative cardiac risk stratification so that the internist may 1) use clinical and electrocardiographic findings to stratify a patient's perioperative risk for myocardial infarction and death ; 2) decide which tests provide useful additional risk-related information ; and 3) understand the benefits, risks, and evidence surrounding the decision to undertake coronary revascularization before elective noncardiac surgery.
A MEDLINE search and review of the reference lists of identified articles.
Sensitivities, specificities, and likelihood ratios for diagnostic tests were calculated, and a quality rating for study methods was applied.
Myocardial infarction and mortality were the major outcomes considered, and a quality rating for study methods was applied.
Clinical and electrocardiographic findings, organized by multivariate prediction indices, accurately identify patients as having low, intermediate, or high risk for myocardial infarction or death.
Pharmacologic stress imaging with thallium or echocardiography probably improves risk stratification for intermediate-risk patients having vascular surgery.
These tests have not been shown to be effective prognostic indicators for patients having nonvascular surgery.
No studies of angiography for risk prediction have been reported. (...)
Mots-clés Pascal : Cardiopathie coronaire, Facteur risque, Peropératoire, Electrocardiographie, Exploration clinique, Guide pratique, Article synthèse, Revue bibliographique, Homme, Appareil circulatoire pathologie, Organisation santé, Electrodiagnostic
Mots-clés Pascal anglais : Coronary heart disease, Risk factor, Intraoperative, Electrocardiography, Clinical investigation, Handbook, Review, Bibliographic review, Human, Cardiovascular disease, Public health organization, Electrodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0438238
Code Inist : 002B25E. Création : 19/12/1997.