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Patients with risk factors often undergo noninvasive cardiac testing before vascular surgery. But does such testing improve outcomes in patients who will receive perioperative β-blockers? In this multinational study, 770 patients with one or two risk factors were randomly assigned to stress testing or no testing. All patients received β-blockers. If testing revealed inducible ischemia, β-blockade was targeted to keep the heart rate below the ischemic threshold; if extensive ischemia was present, patients were considered for revascularization as well.
In the testing arm, 74% of patients had no inducible ischemia, 17% had limited ischemia, and 9% had extensive ischemia. Twelve of 34 patients with extensive ischemia underwent preoperative revas…