Skip to main content
SpringerLink
Log in

Cardiac Disease

  • Chapter
  • First Online:
Perioperative Medicine

  • 2113 Accesses

Abstract

Preoperative cardiac risk assessment has evolved over the past 40 years from a simple global assessment of a patient’s physical status (the ASA classification1) to multivariate risk analyses (Goldman2, Detsky3) to a simplified scoring system (Lee RCRI4) to guidelines (ACC/AHA, ACP). The latest of these is the ACC/AHA guidelines for perioperative cardiac evaluation and management, originally published in 1996 and updated in 20075 to incorporate the RCRI factors. Using these guidelines, which emphasize clinical evaluation and selective cardiac testing (pharmacologic stress tests only in situations where it is likely to change management), physicians are now better able to provide a more accurate assessment of perioperative risk, and the focus has turned to risk reduction strategies. These include revascularization (CABG or PCI), medical therapy (beta-blockers, alpha-agonists, statins), and other intraoperative measures (normothermia, anesthetic technique).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA. 1961;178:261-266.

    PubMed  CAS  Google Scholar 

  2. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845-850.

    Article  PubMed  CAS  Google Scholar 

  3. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986;146(11):2131-2134.

    Article  PubMed  CAS  Google Scholar 

  4. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043-1049.

    PubMed  CAS  Google Scholar 

  5. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50(17):e159-e241.

    Article  PubMed  Google Scholar 

  6. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.

    Article  PubMed  CAS  Google Scholar 

  7. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med. 1989;110(11):859-866.

    PubMed  CAS  Google Scholar 

  8. Reilly DF, McNeely MJ, Doerner D, et al. Self-reported exercise tolerance and the risk of ­serious perioperative complications. Arch Intern Med. 1999;159(18):2185-2192.

    Article  PubMed  CAS  Google Scholar 

  9. Fleisher LA, Beckman JA, Brown KA, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Rhythm Society; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine; Society for Vascular Surgery. J Am Coll Cardiol. 2009;54(22):e13-e118.

    Article  PubMed  Google Scholar 

  10. L’Italien GJ, Paul SD, Hendel RC, et al. Development and validation of a Bayesian model for perioperative cardiac risk assessment in a cohort of 1,081 vascular surgical candidates. J Am Coll Cardiol. 1996;27(4):779-786.

    Article  PubMed  Google Scholar 

  11. Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA. 2001;285(14):1865-1873.

    Article  PubMed  CAS  Google Scholar 

  12. Poldermans D, Bax JJ, Schouten O, et al. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control? J Am Coll Cardiol. 2006;48(5):964-969.

    Article  PubMed  CAS  Google Scholar 

  13. Foster ED, Davis KB, Carpenter JA, Abele S, Fray D. Risk of noncardiac operation in patients with defined coronary disease: the coronary artery surgery study (CASS) registry experience. Ann Thorac Surg. 1986;41(1):42-50.

    Article  PubMed  CAS  Google Scholar 

  14. Eagle KA, Rihal CS, Mickel MC, Holmes DR, Foster ED, Gersh BJ. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3368 operations. CASS Investigators and University of Michigan Heart Care Program. Coronary artery surgery study. Circulation. 1997;96(6):1882-1887.

    PubMed  CAS  Google Scholar 

  15. McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795-2804.

    Article  PubMed  CAS  Google Scholar 

  16. Ward HB, Kelly RF, Thottapurathu L, et al. Coronary artery bypass grafting is superior to percutaneous coronary intervention in prevention of perioperative myocardial infarctions during subsequent vascular surgery. Ann Thorac Surg. 2006;82(3):795-800. discussion 800-791.

    Article  PubMed  Google Scholar 

  17. Biccard BM, Rodseth RN. A meta-analysis of the prospective randomised trials of coronary revascularisation before noncardiac vascular surgery with attention to the type of coronary revascularisation performed. Anaesthesia. 2009;64(10):1105-1113.

    Article  PubMed  CAS  Google Scholar 

  18. Schouten O, van Kuijk JP, Flu WJ, et al. Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study). Am J Cardiol. 2009;103(7):897-901.

    Article  PubMed  Google Scholar 

  19. Monaco M, Stassano P, Di Tommaso L, et al. Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. J Am Coll Cardiol. 2009;54(11):989-996.

    Article  PubMed  Google Scholar 

  20. Grines CL, Bonow RO, Casey DE Jr, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Coll Cardiol. 2007;49(6):734-739.

    Article  PubMed  CAS  Google Scholar 

  21. Nuttall GA, Brown MJ, Stombaugh JW, et al. Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. Anesthesiology. 2008;109(4):588-595.

    Article  PubMed  Google Scholar 

  22. Rabbitts JA, Nuttall GA, Brown MJ, et al. Cardiac risk of noncardiac surgery after percutaneous coronary intervention with drug-eluting stents. Anesthesiology. 2008;109(4):596-604.

    Article  PubMed  Google Scholar 

  23. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and ­cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med. 1996;335(23):1713-1720.

    Article  PubMed  CAS  Google Scholar 

  24. Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999;341(24):1789-1794.

    Article  PubMed  CAS  Google Scholar 

  25. Brady AR, Gibbs JS, Greenhalgh RM, Powell JT, Sydes MR. Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized ­double-blind controlled trial. J Vasc Surg. 2005;41(4):602-609.

    Article  PubMed  CAS  Google Scholar 

  26. Juul AB, Wetterslev J, Gluud C, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded ­multicentre trial. BMJ. 2006;332(7556):1482.

    Article  PubMed  Google Scholar 

  27. Yang H, Raymer K, Butler R, Parlow J, Roberts R. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J. 2006;152(5):983-990.

    Article  PubMed  CAS  Google Scholar 

  28. Lindenauer PK, Pekow P, Wang K, Mamidi DK, Gutierrez B, Benjamin EM. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349-361.

    Article  PubMed  CAS  Google Scholar 

  29. Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371(9627):1839-1847.

    Article  PubMed  CAS  Google Scholar 

  30. Dunkelgrun M, Boersma E, Schouten O, et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg. 2009;249(6):921-926.

    Article  PubMed  Google Scholar 

  31. van Lier F, Schouten O, Hoeks SE, et al. Impact of prophylactic beta-blocker therapy to ­prevent stroke after noncardiac surgery. Am J Cardiol. 2010;105(1):43-47.

    Article  PubMed  Google Scholar 

  32. van Lier F, Schouten O, van Domburg RT, et al. Effect of chronic beta-blocker use on stroke after noncardiac surgery. Am J Cardiol. 2009;104(3):429-433.

    Article  PubMed  Google Scholar 

  33. Flu W, van Kuijk J, Chonchol M, et al. Timing of pre-operative beta-blocker treatment in vascular surgery patients. J Am Coll Cardiol. 2010;56:1922-1929.

    Article  PubMed  Google Scholar 

  34. Fleischmann KE, Beckman JA, Buller CE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade. J Am Coll Cardiol. 2009;54(22):2102-2128.

    Article  PubMed  Google Scholar 

  35. Poldermans D, Bax JJ, Boersma E, et al. ESC Committee for Practice Guidelines (CPG). Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: the Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA). Eur Heart J. 2009;30(22):2769-2812. Epub 2009 Aug 27.

    Article  PubMed  Google Scholar 

  36. Wijeysundera DN, Bender JS, Beattie WS. Alpha-2 adrenergic agonists for the prevention of cardiac complications among patients undergoing surgery. Cochrane Database Syst Rev. 2009;(4):CD004126.

    Google Scholar 

  37. Wallace AW, Galindez D, Salahieh A, et al. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology. 2004;101(2):284-293.

    Article  PubMed  CAS  Google Scholar 

  38. Kapoor AS, Kanji H, Buckingham J, Devereaux PJ, McAlister FA. Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ. 2006;333(7579):1149.

    Article  PubMed  CAS  Google Scholar 

  39. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004;39(5):967-975, discussion 975-966.

    Article  PubMed  Google Scholar 

  40. Schouten O, Boersma E, Hoeks SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med. 2009;361(10):980-989.

    Article  PubMed  CAS  Google Scholar 

  41. Schouten O, Kertai MD, Bax JJ, et al. Safety of perioperative statin use in high-risk patients undergoing major vascular surgery. Am J Cardiol. 2005;95(5):658-660.

    Article  PubMed  CAS  Google Scholar 

  42. Fleisher LA. Preoperative evaluation of the patient with hypertension. JAMA. 2002; 287(16):2043-2046.

    Article  PubMed  Google Scholar 

  43. Bohm M, Maack C, Wehrlen-Grandjean M, Erdmann E. Effect of bisoprolol on perioperative complications in chronic heart failure after surgery (Cardiac Insufficiency Bisoprolol Study II (CIBIS II)). Z Kardiol. 2003;92(8):668-676.

    Article  PubMed  CAS  Google Scholar 

  44. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116(15):1736-1754.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine-Medical Consultation Service, SUNY Downstate - Kings County Hospital Center, 450 Clarkson Ave, 68, Brooklyn, NY, 11203, USA

    Steven L. Cohn

Authors
  1. Steven L. Cohn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven L. Cohn .

Editor information

Editors and Affiliations

  1. Downstate Medical Center, State University of New York (SUNY), Hicks St. 339, Brooklyn, 11201, New York, USA

    Steven L. Cohn

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Cohn, S.L. (2011). Cardiac Disease. In: Cohn, S. (eds) Perioperative Medicine. Springer, London. https://doi.org/10.1007/978-0-85729-498-2_20

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-498-2_20

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-497-5

  • Online ISBN: 978-0-85729-498-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation