Negative predictive value of dobutamine stress echocardiography for perioperative risk stratification in patients with cardiac risk factors and reduced exercise capacity undergoing non‐cardiac surgery

Background Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with greater than one recognised cardiac risk factor and self‐reported reduced exercise capacity. Aim To determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major non‐cardiac surgery. Methods Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre were retrospectively reviewed to determine rates of major adverse cardiac events (MACE) during the index hospitalisation and 30 days post‐discharge. Echocardiography and outcome data were obtained through a folder audit and echolab database. Results Out of the 79 DSE performed for perioperative risk stratification, 11 (14%) were positive (DSE +ve) and 68 (86%) were negative (DSE −ve). Management in the DSE +ve group included medical optimisation without invasive intervention (n = 7(64%)), diagnostic coronary angiography (n = 3(27%)) and coronary artery bypass graft (n = 1(9%)). None of the patients underwent percutaneous coronary intervention preoperatively. Perioperative MACE in the DSE +ve group was 36% compared to 4% in the DSE‐ve group (P = 0.006). DSE +ve was a powerful predictor of perioperative inpatient MACE (OR 12.4, 95% CI 2.3–67, P = 0.003). The positive predictive value of DSE +ve status was 36%, whereas the negative predictive value of DSE‐ve status for perioperative MACE was 96%. Conclusion DSE for perioperative risk stratification had a high clinical utility in patients undergoing major non‐cardiac surgery. In particular, a normal DSE had a high negative predictive value for perioperative MACE.