Predicting perioperative cardiac risk.
Cardiovascular complications are the major cause of perioperative morbidity and mortality of patients undergoing major vascular surgery. This is related to the frequent presence of an underlying coronary artery disease. This paper reviews the pathology of perioperative cardiac complications and cardiac risk assessment and risk reduction strategies. Guidelines of the American College of Cardiology and American Heart Association for the evaluation of cardiac risk for noncardiac surgery may provide the necessary framework for the assessment and management of patients undergoing major vascular surgery. Based on the American College of Cardiology and American Heart Association guidelines and data from contemporary studies, patients without risk factors are considered to be at low risk and do not require additional evaluations for coronary artery disease. Patients with 1 or 2 cardiac risk factors represent an intermediate-risk group for perioperative cardiac complications. If beta-blockers are prescribed, the probability of cardiac complications is low and there is no need for further noninvasive testing. Patients with 3 or more risk factors are at high risk for cardiac complications and the use of noninvasive testing may help further refine cardiac risk based on the presence and absence of test-induced myocardial ischemia. beta-Blockers should be prescribed to all patients, and coronary revascularization should be reserved for high-risk patients who have a clearly defined need for revascularization independent of the need for major vascular surgery.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Miklos D
MD
Kertai
Jan
J
Klein
Jeroen J
JJ
Bax
Don
D
Poldermans
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007430:Intraoperative Care; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D014656:Vascular Surgical Procedures
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors