8. PCM Risk Stratification

Do we have such a test? We have lots of candidate tests: exercise stress testing, radionuclide ventriculography, Holter, stress echocardiography, coronary angiography, thallium scintigraphy, and History and Physical Exam. Any test must be proven effective in prospective blinded trial. At the present time, the only test we have that is proven to predict perioperative cardiac events is the history and physical with attention to coronary artery disease, peripheral vascular disease, age, hypertension, diabetes, smoking, and hyperlipidemia. The H&P isn't sexy or exciting, but it does work.