title: [After ACC/AHA and ESC Guidelines: Pre-operative cardiological evaluation in non-cardiac surgery: certainties, controversial areas and opportunities for a team approach].
abstract: A standardized and evidence-based approach to the cardiological management of patients undergoing noncardiac surgery has been recently defined by Task Forces of the American Heart Association (AHA), American College of Cardiology (ACC) and the European Society of Cardiology (ESC) that published their guidelines in 2007 and 2009, respectively. Both the recommendations moved from risk indices to a practical, stepwise approach of the patient, which integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure. In the present paper the main topics of the guidelines are discussed, and moreover, emphasis is placed on four controversial issues such as the use of prophylactic coronary revascularization in patients with myocardial ischemia, the perioperative management of patients with congestive heart failure, the routine use of betablockers and statins, and, finally, the management of antiplatelet therapies in patients with coronary stents. In addition to promoting an improvement of immediate perioperative care, the preoperative cardiological evaluation should be a challenge for identifying subjects with enhanced risk of cardiovascular events, who should be treated and monitored during a long-term follow-up.
authors.affiliation: UOC Cardiologia, Ospedale Bellaria, Via Altura, 3, I-40139 Bologna, Italy. stefano.urbinati@ausl.bo.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Urbinati
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Furio
authors.initials: F
authors.lastname: Colivicchi
authors.forename: Carmine
authors.initials: C
authors.lastname: Riccio
authors.forename: Maurizio Giuseppe
authors.initials: MG
authors.lastname: Abrignani
authors.forename: Alberto
authors.initials: A
authors.lastname: Genovesi-Ebert
authors.forename: Francesco
authors.initials: F
authors.lastname: Fattirolli
authors.forename: Stefania
authors.initials: S
authors.lastname: De Feo
authors.forename: Simona
authors.initials: S
authors.lastname: Gambetti
authors.forename: Massimo
authors.initials: M
authors.lastname: Uguccioni
mesh_terms: D002309:Cardiology / Q000592:standards; D015897:Comorbidity; D005060:Europe; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000628:therapy; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D012955:Societies, Medical; D013514:Surgical Procedures, Operative; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors