Advertisement

Preoperative Cardiovascular Risk Assessment for Non-cardiac Surgery

  • John E. Reuter
  • John C. Teeters
Chapter

Abstract

The purpose of preoperative evaluation is to optimize the patient’s status before surgery and thereby minimize risk. Generally the most feared post-operative cardiac complications are myocardial infarction, heart failure, malignant arrhythmias, and death. Factors to consider during the preoperative evaluation are patient risk factors, patient functional capacity, and the type of surgery the patient will undergo. Patients with comorbidities such as peripheral arterial disease have higher incidences of underlying coronary artery disease and left ventricular dysfunction. Deconditioned patients also have a higher incidence of cardiac complications. Finally, certain procedures, such as vascular surgery or major thoracic and abdominal procedures, predispose to myocardial ischemia due to greater blood loss, fluid shifts, increased myocardial oxygen demand (due to increased heart rate and blood pressure), and increased post-operative platelet reactivity.

Keywords

Percutaneous Coronary Intervention Beta Blocker Clinical Risk Factor Bare Metal Stent Noncardiac Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Lee TH et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043.PubMedGoogle Scholar
  2. 2.
    Fleisher LA 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: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:e13.PubMedCrossRefGoogle Scholar
  3. 3.
    Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med. 1995;333:1750.PubMedCrossRefGoogle Scholar
  4. 4.
    McFalls EO et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351:2795.PubMedCrossRefGoogle Scholar
  5. 5.
    Leon MB et al. A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting Stent Anticoagulation Restenosis Study Investigators. N Engl J Med. 1998;339:1665.PubMedCrossRefGoogle Scholar
  6. 6.
    Lindenauer PK et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353:349.PubMedCrossRefGoogle Scholar
  7. 7.
    Dunkelgrun M 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;249:921–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Winchester DE et al. Evidence of pre-procedural statin therapy: a meta-analysis of randomized trials. J Am Coll Cardiol. 2010;56:1099–109.PubMedCrossRefGoogle Scholar
  9. 9.
    POISE Study Group, Devereaux PJ, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet. 2008;371:1839.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  1. 1.Department of CardiologyUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Division of Cardiology, Highland HospitalUniversity of Rochester Medical CenterRochesterUSA

Personalised recommendations