Preoperative cardiac evaluation of the patient with vascular disease.

OBJECTIVE: To review the literature and evaluate the investigation of cardiac risk factors, by tests and intraoperative predictors, that will identify patients at high risk for vascular surgery. DATA SOURCES: An English-language literature review of Index Medicus articles from 1961 to 1992. STUDY SELECTION: Published articles that addressed preoperative risk factors, diagnostic tests and intraoperative predictors were selected by multiauthor consensus. DATA EXTRACTION: Independent extraction by multiple authors was utilized to abstract and assess the quality of data from selected references, with consensus determining inclusion or exclusion. DATA SYNTHESIS: From evaluation of published data, a number of factors were considered to put a patient scheduled to undergo vascular surgery at higher risk: symptomatic coronary artery disease; clinical evidence of coronary artery disease, congestive heart failure, aortic stenosis and recent myocardial infarction; laboratory findings of significant disease with cardiomegaly or significant dysrhythmias; and no symptoms but two or more risk factors. CONCLUSIONS: The authors propose an algorithm for the investigation of patients and stratification of risk to be considered in weighing the dangers versus the benefits of vascular surgery.