To the Editor.
—Dr Mason and colleagues1 have elegantly brought into question the following common sequence: preoperative "noninvasive" testing for coronary disease, followed by coronary angiography, then either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery, and then finally the procedure the patient needed in the first place. While applauding the authors' presentation, we take exception to "close monitoring of cardiac status" and "more intensive surveillance" as an alternative to the intense preoperative approach. Most investigations suggest that cardiac events occur with the greatest frequency in the 72 hours after surgery.2,3 The vague phrases used by the authors can only be interpreted as more intense monitoring (eg, continuous real-time electrocardiographic [ECG] monitoring for ST segment changes) for a period of days, and the only place this can be done in most institutions is the intensive care unit. These phrases also might be interpreted as recommending increased
Ramsay J, Thomas B. Preoperative Cardiac Evaluation and Perioperative Monitoring for Noncardiac Vascular Surgery. JAMA. 1995;274(21):1671. doi:10.1001/jama.1995.03530210025012