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August 21, 1996

Intensity of Testing and Invasive Procedures-Reply

Author Affiliations

Maine Medical Center Portland
Dartmouth-Hitchcock Medical Center Lebanon, NH
Maine Medical Assessment Foundation Augusta

JAMA. 1996;276(7):529. doi:10.1001/jama.1996.03540070025023

In Reply.  —Whether patients with known or suspected noncardiac vascular disease should have evaluation for coronary artery disease is an important clinical question. Patients with peripheral vascular disease are at a high risk for fatal and nonfatal cardiac events.1 While significant work has been done concerning the preoperative cardiac evaluation in patients undergoing noncardiac vascular surgery,2 debate continues about how to manage these patients even after the extent of their disease is known.3 Finally, there is no consensus about whether case finding and risk stratification is either appropriate or costeffective in the population being evaluated in a vascular laboratory. Thus, the question of the use of exercise testing raised by Dr Crouse and colleagues is relevant. Unfortunately, our data could not allow us to discern between those undergoing testing for symptoms and those undergoing testing for case finding and stratification.However, the use of exercise testing in the setting