Choosing Wisely:

Patients who have no cardiac history and good functional status do not require preoperative stress testing prior to noncardiac thoracic surgery.

Rationale and Comments: Functional status has been shown to be reliable for prediction of perioperative and long-term cardiac events. In highly functional asymptomatic patients, management is rarely changed by preoperative stress testing. It is therefore appropriate to proceed with the planned surgery without it. Preoperative stress testing should be reserved for patients with significant clinical risk factors for cardiac complications such as history, symptom, or signs of ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus, or peripheral vascular disease. It may also be appropriate to perform preoperative cardiac testing on patients with a low functional status (unable to carry out anything more than minor physical activity) since inactivity in these patients may mask otherwise significant cardiac disease.
Sponsoring Organizations:
  • Society of Thoracic Surgeons
  • Sources:
  • ACC/AHA, ESC guidelines
  • Disciplines:
  • Cardiovascular
  • Surgical
  • References: • Fleisher LA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for non-cardiac surgery. Circulation. 2007;116:e418-99.
    • Poldermans D, et al. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J. 2009;30:2769-812.
    • Brunelli A, et al. Recalibration of the revised cardiac risk index in lung resection candidates. Ann Thorac Surg. 2010;90:199-203.
    • Wijeysundera DN, et al. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study. BMJ. 2010;340:b5526.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now