utility of detailed preoperative cardiac testing and incidence of postthoracotomy myocardial infarction objective recent literature has questioned the efficacy of routine detailed preoperative cardiac ischemia testing and preoperative cardiac intervention before noncardiac surgical proceduresmethods we performed a retrospective review of patients undergoing thoracotomy n 294 between january of 1999 and january of 2005results the median age was 62 years detailed preoperative cardiac testing was performed on 184 patients 63 and went beyond a thorough history physical examination and electrocardiogram to include at least one of the following dobutamine stress echo n 116 nuclear stress test n 66 treadmill test n 8 and coronary angiogram n 40 evidence for coronary disease was detected in 43 of tests 99230 performed revascularization was performed in 10 of all patients 440 who underwent coronary angiography postoperative myocardial infarction occurred in 7 patients 24 with 4 myocardial infarctionrelated mortalities no significant difference was found in the incidence of myocardial infarction in patients with n 184 or without n 110 detailed preoperative cardiac testing 33 vs 09 p 29 of the 4 patients 14 who underwent revascularization to treat coronary lesions identified during prethoracotomy workup 2 had a myocardial infarction 1 of which was caused by thrombosis of a coronary stent in the subset of patients who underwent lobectomy n 149 detailed cardiac testing was performed on 107 patients 72 the incidence of myocardial infarction was similar in tested and untested patients 28 vs 24 respectively p 10conclusion selective use of detailed preoperative cardiac testing refines risk stratification and identifies patients for corrective cardiac interventions however it did not prove fully protective against myocardial infarction after thoracotomy in our study