ArticleBMJ (Clinical research ed.)2010
Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study.
Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery.The Cochrane database of systematic reviews · 2021Pooled it
- Pre-operative stress testing in the evaluation of patients undergoing non-cardiac surgery: A systematic review and meta-analysis.PloS one · 2019Pooled it
- Guideline
- Korean guidelines for the appropriate use of cardiac CT.Korean journal of radiologyGuideline
- 3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology.Arquivos brasileiros de cardiologiaGuideline
- Update in Perioperative Ischemic Workup: Integrating 2024 AHA/ACC Guidelines and Contemporary Evidence.Journal of cardiovascular development and disease · 2026Review
- Description and validation of the Postoperative Discharge Recovery State outcome: a patient-partnered population-based cohort study.British journal of anaesthesia · 2025Article
- Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024.Arquivos brasileiros de cardiologia · 2024Article
- The effect of pre-habilitation programs on surgical outcomes among patients undergoing elective cardiac surgery.Bioinformation · 2024Article
- Diagnostic and prognostic value of cardiac stress testing before major noncardiac surgery-A cohort study.Journal of clinical anesthesia · 2023Article
- Consequences of preoperative cardiac stress testing-A cohort study.Journal of clinical anesthesia · 2023Article
- Complications Following Elective Major Noncardiac Surgery Among Patients With Prior SARS-CoV-2 Infection.JAMA network open · 2022Article
- Troponin testing after noncardiac surgery: a population-based historical cohort study on variation and factors associated with testing in Ontario.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2022Article
- Standardized Preoperative Pathways Determining Preoperative Echocardiogram Usage Continue to Improve Hip Fracture Quality.Geriatric orthopaedic surgery & rehabilitation · 2022Article
- Article
- Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the 'asymptomatic' patient.Journal of orthopaedic surgery and research · 2020Article
- Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study.British journal of anaesthesia · 2019Article
- Prevalence and clinical characteristics of inappropriate myocardial perfusion imaging tests at a community hospital.BMJ open quality · 2019Article
- Towards an emotional 'stress test': a reliable, non-subjective cognitive measure of anxious responding.Scientific reports · 2017Article
- Preoperative Cardiac Evaluation and Management of the Patient Undergoing Major Vascular Surgery.International anesthesiology clinics · 2016Review
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5 authors.
Funding
Abstract
objectiveTo determine the association of non-invasive cardiac stress testing before elective intermediate to high risk non-cardiac surgery with survival and hospital stay.
designPopulation based retrospective cohort study.
settingAcute care hospitals in Ontario, Canada, between 1 April 1994 and 31 March 2004.
participantsPatients aged 40 years or older who underwent specific elective intermediate to high risk non-cardiac surgical procedures.
interventionsNon-invasive cardiac stress testing performed within six months before surgery.
main outcome measuresPostoperative one year survival and length of stay in hospital.
resultsOf the 271 082 patients in the entire cohort, 23 991 (8.9%) underwent stress testing. After propensity score methods were used to reduce important differences between patients who did or did not undergo preoperative stress testing and assemble a matched cohort (n=46 120), testing was associated with improved one year survival (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.99; P=0.03) and reduced mean hospital stay (difference -0.24 days, 95% CI -0.07 to -0.43; P<0.001). In an analysis of subgroups defined by Revised Cardiac Risk Index (RCRI) class, testing was associated with harm in low risk patients (RCRI 0 points: HR 1.35, 95% CI 1.05 to 1.74), but with benefit in patients who were at intermediate risk (RCRI 1-2 points: 0.92, 95% CI 0.85 to 0.99) or high risk (RCRI 3-6 points: 0.80, 95% CI 0.67 to 0.97).
conclusionsPreoperative non-invasive cardiac stress testing is associated with improved one year survival and length of hospital stay in patients undergoing elective intermediate to high risk non-cardiac surgery. These benefits principally apply to patients with risk factors for perioperative cardiac complications.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.