Abstract
With an aging population and advances in surgical techniques, an increasing number of patients with cardiac risk factors are undergoing non-cardiac surgery. The vast majority of surgeries are performed electively, allowing an interlude where strategies to reduce risk may be implemented. An appropriate preoperative evaluation when time allows is necessary to minimize the risk of potential cardiac complications and to optimize patient safety. The evaluation of these patients prior to non-cardiac surgery is one of the most common reasons for cardiology consultation. Cardiovascular complications are the leading cause of death within 30 days of non-cardiac surgery. We will discuss how to assess perioperative cardiac risk using clinical risk factors and type of surgery.
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References
Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173:627–34.
Eagle KA, Baliga RR, editors. Practical cardiology: evaluation and treatment of common cardiovascular disorders. Philadelphia: Lippincott, Williams & Wilkins.
Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373:2258–69.
Dalby Kristensen S, Knuuti J, Saraste A, Anker S, Erik Bøtker H, De Hert S. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 35(15):2383–431. https://doi.org/10.1093/eurheartj/ehu282.
Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. J Am Coll Cardiol. 2014;64(22):e77–137.
Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297:845–50.
Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124:381–7.
Patel AY, Eagle KA, Vaishnava P. Cardiac risk of noncardiac surgery. J Am Coll Cardiol. 2015;66:2140–8.
Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217:833–842.e3.
Duceppe E, Parlow J, Macdonald P, et al. Canadian Cardiovascular Society Guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017;33:17–32.
POISE Study Group, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.
London MJ, Hur K, Schwartz GG, Henderson WG. Association of perioperative β-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA. 2013;309:231–8.
Mcfalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795–804.
Priebe H-J. Preoperative cardiac management of the patient for non-cardiac surgery: an individualized and evidence-based approach. Br J Anaesth. 2011;107:83–96.
Eacts CS, Germany CH, Rosenhek R, France EL, Rodriguez D, Tornos P, Vahanian A, Luis J. 2017 ESC / EACTS Guidelines for the management of valvular heart disease. The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European. Eur Heart J. 2017;38(36):2739–91.
Raju MG, Pachika A, Punnam SR, Gardiner JC, Shishehbor MH, Kapadia SR, Abela GS. Statin therapy in the reduction of cardiovascular events in patients undergoing intermediate-risk noncardiac, nonvascular surgery. Clin Cardiol. 2013;36:456–61.
Rossini R, Musumeci G, Capodanno D, et al. Perioperative management of oral antiplatelet therapy and clinical outcomes in coronary stent patients undergoing surgery. Results of a multicentre registry. Thromb Haemost. 2015;113:272–82.
Rechenmacher SJ, Fang JC. Bridging anticoagulation primum non nocere. J Am Coll Cardiol. 2015;66:1392–403.
Flaker GC, Theriot P, Binder LG, Dobesh PP, Cuker A, Doherty JU. Management of periprocedural anticoagulation a survey of contemporary practice. J Am Coll Cardiol. 2016;68(2):217–26. https://doi.org/10.1016/j.jacc.2016.04.042.
Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med. 2013;368:2113–24.
NLM C, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, Pell JP, Newby DE, Scottish Coronary Revascularisation Register Steering Committee. Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery. Circ Cardiovasc Interv. 2010;3:236–42.
Hawn MT, Graham LA, Richman JR, Itani KMF, Plomondon ME, Altom LK, Henderson WG, Bryson CL, Maddox TM. The incidence and timing of noncardiac surgery after cardiac stent implantation. J Am Coll Surg. 2012;214:658–66.
Levine GN, et al. 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Am Coll Cardiol. 2016;68:1082–115. https://doi.org/10.1016/j.jacc.2016.03.513.
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Bleszynski, P.A., Shenkman, H., Mieszczanska, H.Z. (2018). Preoperative Evaluation and Management of the Patient Prior to Non-cardiac Surgery. In: Mieszczanska, H., Budzikowski, A. (eds) Cardiology Consult Manual. Springer, Cham. https://doi.org/10.1007/978-3-319-89725-7_9
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DOI: https://doi.org/10.1007/978-3-319-89725-7_9
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