title: Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.
abstract: The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.
authors.affiliation: Department of Medicine, University of Montreal, Montreal, Quebec, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Duceppe
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address: parlowj@queensu.ca.
authors.forename: Joel
authors.initials: J
authors.lastname: Parlow
authors.affiliation: Cape Breton Regional Hospital, Cape Breton, Nova Scotia, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: MacDonald
authors.affiliation: Division of Cardiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kristin
authors.initials: K
authors.lastname: Lyons
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McMullen
authors.affiliation: Department of Surgery, Section of Thoracic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Sadeesh
authors.initials: S
authors.lastname: Srinathan
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Graham
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Tandon
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Styles
authors.affiliation: Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Amal
authors.initials: A
authors.lastname: Bessissow
authors.affiliation: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bryson
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D002170:Canada; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D059035:Perioperative Period; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012955:Societies, Medical; D013514:Surgical Procedures, Operative