The predictive value of preoperative silent ischemia for postoperative ischemic cardiac events in vascular and nonvascular surgery patients

Silent ischemia has been shown to be predictive of postoperative cardiac events in vascular surgery patients. However, no controlled data regarding its predictive value in nonvascular surgery patients are available. We studied 67 vascular sugery and 79 nonvascular surgery patients, all of whom had increased risk for cardiac disease, to determine whether the occurrence of preoperative silent myocardial ischemia is predictive of morbid postoperative cardiac events in a diverse surgical group. The presence of preoperative silent ischemia in both nonvascular and vascular surgical patients had similar predictive value (0.38 and 0.38, respectively) for postoperative morbid cardiac events. The absence of preoperative silent ischemia predicted an excellent outcome in patients undergoing nonvascular surgery (0.99), but was a less robust predictor in our vascular patients (0.86). These data suggest that the functional status of the coronary circulation is one of the most important determinants of outcome.