Ethan A. Halm, MD; Warren S. Browner, MD, MPH; Julio F. Tubau, MD
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Halm E., Browner W., Tubau J.; Preoperative Echocardiography for Noncardiac Surgery. Ann Intern Med. 1997;126:919-920. doi: 10.7326/0003-4819-126-11-199706010-00028
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Published: Ann Intern Med. 1997;126(11):919-920.
Dr. Palen wonders about “the manner in which information from the traditional clinical evaluation was incorporated into the clinical model” of cardiac risk. For each cardiac event, we used stepwise multivariable regression to identify the clinical factors that were the best predictors of the outcome of interest and then added the echocardiographic data to that “best” clinical model to see whether the diagnostic test added any incremental information. For example, our clinical model of all cardiac outcomes included vascular surgery, history of dysrhythmia, definite coronary artery disease, and use of digoxin (see Tables 4 and 7 in our report). In our cohort, the clinical risk models we presented were better predictors of adverse events than were the Goldman cardiac risk index , Detsky risk index , and American Society of Anesthesiologists classification (as we previously reported ). Even so, analyses that used the aforementioned cardiac risk indices produced similar findings. The echocardiogram provided no significant prognostic information in addition to that predicted by the cardiac risk indices.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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