Preoperative Cardiac Stress Testing in Patients Undergoing Vascular Surgery: Preliminary Results of a Systematic Review

Abstract

Introduction: Coronary artery disease (CAD) is a major cause of perioperative morbidity and mortality in patients undergoing vascular surgery. Several tests have been used to assess risk of postoperative cardiac complications. In this systematic review we compared the prognostic accuracy of preoperative cardiac stress tests in predicting postoperative cardiac events in patients undergoing vascular surgery. Methods: A study protocol was designed in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and registered with the International Prospective Register of Systematic Reviews (CRD42019117846). A search of Medline, Embase, Scopus, CINAHL and the Cochrane library databases was conducted to identify studies correlating postoperative cardiac events of patients undergoing vascular surgery to preoperative cardiac stress tests between 1998 and 2018. For the purpose of this review, only pharmacological stressing agents were included. Quality was assessed using the Newcastle-Ottawa scores (NOS). Sensitivity and specificity of each test was calculated from published results. Summary receiver operator characteristic (SROC) curve and forest plots were used to compare different tests. Results: A total of 17 studies (3182 patients) were included. The mean age was 67±3 years and 82% were male. Twelve studies (71%) were prospective and 13 (76%) had a Newcastle-Ottawa scale score ³7. Seven studies used stress echocardiography (SE), 8 myocardial perfusion imaging (MPI) and 2 studies compared SE and MPI. With regards to predicting postoperative cardiac events, MPI and SE had a sensitivity of 70% (95% confidence interval [CI] 44% to 83%) and 49% (95% CI 32% to 70%) respectively whilst specificity was 60% (95% CI 45% to 79%) and 85% (95% CI 74% to 87%) respectively. Conclusion: Overall prognostic accuracy of cardiac stress tests for postoperative cardiac events after vascular surgery remains modest. Further research is required in vascular surgery patients using newer techniques and modalities that have been shown to have higher diagnostic accuracy of predicting CAD. Disclosure: Nothing to disclose