1 research outputs found
A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery
OBJECTIVE: To evaluate the discriminatory value and compare the predictive
performance of six non-invasive tests used for perioperative cardiac risk
stratification in patients undergoing major vascular surgery. DESIGN:
Meta-analysis of published reports. METHODS: Eight studies on ambulatory
electrocardiography, seven on exercise electrocardiography, eight on
radionuclide ventriculography, 23 on myocardial perfusion scintigraphy,
eight on dobutamine stress echocardiography, and four on dipyridamole
stress echocardiography were selected, using a systematic review of
published reports on preoperative non-invasive tests from the Medline
database (January 1975 and April 2001). Random effects models were used to
calculate weighted sensitivity and specificity from the published results.
Summary receiver operating characteristic (SROC) curve analysis was used
to evaluate and compare the prognostic accuracy of each test. The relative
diagnostic odds ratio was used to study the differences in diagnostic
performance of the tests. RESULTS: In all, 8119 patients participated in
the studies selected. Dobutamine stress echocardiography had the highest
weighted sensitivity of 85% (95% confidence interval (CI) 74% to 97%) and
a reasonable specificity of 70% (95% CI 62% to 79%) for predicting
perioperative cardiac death and non-fatal myocardial infarction. On SROC
analysis, there was a trend for dobutamine stress echocardiography to
perform better than the other tests, but this only reached significance
against myocardial perfusion scintigraphy (relative diagnostic odds ratio
5.5, 95% CI 2.0 to 14.9). CONCLUSIONS: On meta-analysis of six
non-invasive tests, dobutamine stress echocardiography showed a positive
trend towards better diagnostic performance than the other tests, but this
was only significant in the comparison with myocardial perfusion
scintigraphy. However, dobutamine stress echocardiography may be the
favoured test in situations where there is valvar or left ventricular
dysfunction