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Perioperative Cardiac Risk Stratification

  • F. R. B. G. Galas
  • L. A. Hajjar
  • J. O. C. AulerJr.
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)

Abstract

Cardiovascular events are considered the main cause of death in the perioperative period. The most important events are acute myocardial infarction (MI), unstable angina, cardiac failure, severe arrhythmias, nonfatal cardiac arrest, and death. Patients experiencing an MI after noncardiac surgery have a hospital mortality rate of 15–25% [1, 2], and nonfatal perioperative MI is an independent risk factor for cardiovascular death and nonfatal MI during the 6 months following surgery. Patients who have a cardiac arrest after noncardiac surgery have a hospital mortality rate of 65%, and nonfatal perioperative cardiac arrest is a risk factor for cardiac death during the 5 years following surgery [3, 4]. The objectives of preoperative evaluation are: (a) performing an evaluation of the patient’s current medical status; (b) making recommendations concerning the evaluation, management, and risk of cardiac problems over the entire perioperative period; and (c) providing a clinical risk profile that the patient, primary physician, anesthesiologist, and surgeon can use in making treatment decisions that may influence short- and long-term outcomes. No test should be performed unless it is likely to influence patient treatment [5]. The cost of risk stratification cannot be ignored. Accurate estimation of a patient’s risk for postoperative cardiac events (MI, unstable angina, ventricular tachycardia, pulmonary edema, and death) after surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research.

Keywords

Aortic Stenosis Cardiac Risk Dobutamine Stress Echocardiography Canadian Cardiovascular Society Revise Cardiac Risk Index 
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.

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Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • F. R. B. G. Galas
    • 1
  • L. A. Hajjar
    • 1
  • J. O. C. AulerJr.
    • 2
  1. 1.Surgical Intensive Care Unit and Department of Anesthesiology, Hospital das Clínicas, InCor (Heart Institute)University of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Surgical Intensive Care Unit Department and InCor (Heart Institute)University of São Paulo Medical SchoolSão PauloBrazil

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