Assessment of operative risk with electrocardiographic exercise testing in patients with peripheral vascular disease

Doppler ankle blood pressures were obtained in 100 consecutive patients with peripheral arterial insufficiency after treadmill exercise. A twelve lead electrocardiogram was monitored during and after exercise. Despite a restricted ability to exercise because of peripheral vascular insufficiency, forty-six patients had ventricular dysrhythmia or ischemia, or both, usually without associated symptoms. Electrocardiographic monitoring during treadmill exercise proved a useful predictor of postoperative complications. Thirty-two vascular operations were performed in patients with no electrocardiographic evidence of ischemia. No patient had a postoperative myocardial infarction or died. Sixteen vascular procedures were performed in patients with ischemic responses on exercise electrocardiography. Six patients had postoperative myocardial infarctions, two of which were fatal. Electrocardiographic monitoring during treadmill exercise for peripheral vascular insufficiency is recommended (1) to assess the severity of coronary artery disease and the likelihood of postoperative complications, and (2) as a precautionary measure to identify potentially dangerous dysrhythmias or ischemia during exercise before the development of clinical symptoms.