A new algorithm for preoperative cardiac assessment in patients undergoing pulmonary resection.

From January 2001 through June 2002, 128 consecutive patients undergoing lung resection for various diseases were evaluated preoperatively by a cardiologist at our institution in order to predict postoperative cardiac complications in pulmonary surgery. Our assessment algorithm consisted of the following: Smoking, hypertension, hyperlipidemia, advanced age, diabetes mellitus, and history of cardiac disease or angina pectoris were considered as risk factors. A stress test was performed when at least 2 of the first 3 risk factors or at least 1 of the last 3 risk factors was present. Coronary angiography was performed in the case of a positive stress test. Patients were classified as low-risk when there was no need for a stress test. Patients were considered as intermediate-risk when a stress test revealed no ischemia or if there was a history of congestive heart failure or valvular disease. Patients in whom coronary artery disease was detected on angiography were classified as high-risk. Ninety-five of our patients were in the low-risk group, and 29 were in the intermediate-risk group. After lung resection, cardiac complications developed in 4 patients in the low-risk group (atrial fibrillation) and in 8 patients in the intermediate-risk group (5 atrial fibrillation and 3 paroxysmal atrial tachycardia). The overall cardiac complication rate was 9.7%. No death occurred due to cardiac events. The difference in the incidence of arrhythmias between the low- and the intermediate-risk groups was significant (P < 0.05). We present this simple algorithm for preoperative cardiac evaluation in patients scheduled to undergo lung resection, and we suggest that it may be possible to predict postoperative cardiac complications with this method.