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December 6, 1995

Preoperative Cardiac Evaluation and Perioperative Monitoring for Noncardiac Vascular Surgery-Reply

Author Affiliations

Stanford University School of Medicine Stanford, Calif

JAMA. 1995;274(21):1672. doi:10.1001/jama.1995.03530210025014

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In Reply.  —Drs Ramsay and Thomas express concern that our use of the terms "close monitoring" and "intensive surveillance" endorse use of specific expensive monitoring, but this was not our intention. Our study did not assume any specific method of monitoring would be used. Our own practice includes continuous ECG monitoring for 24 hours, clinical follow-up by the cardiovascular consult service, either antiplatelet or anticoagulant therapy, and appropriate antiischemic medications in the perioperative period. Selected patients receive further intraoperative or postoperative surveillance, but this practice is highly individualized, and few data are available concerning the cost efficacy and cost-effectiveness of pulmonary artery catheterization or transesophageal echocardiography for perioperative monitoring.We agree with Drs Fleisher and Lehmann that if the operative mortality of noncardiac vascular surgery is high (eg, 9.5%), preoperative coronary angiography has greater potential to reduce overall risk. Our base case analysis assumed a much lower operative risk, and

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