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(Circulation. 2006;113:1361-1376.)
© 2006 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

Andrew Auerbach, MD, MPH; Lee Goldman, MD

From the Department of Medicine University of California, San Francisco.

Correspondence to Lee Goldman, MD, 505 Parnassus Ave, Room M-994, Box 0120, San Francisco, CA 94143-0120. E-mail goldman@medicine.ucsf.edu

Key Words: cardiovascular diseases • epidemiology • myocardial infarction • risk factors • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Accurate estimation of a patient’s risk for postoperative cardiac events (eg, myocardial infarction, unstable angina, ventricular tachycardia, pulmonary edema, and death) after noncardiac surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research. This review addresses selected issues in clinical risk assessment, approaches to using diagnostic tests, choices among preventive interventions, and postoperative monitoring. Although we have not used a formal systematic review protocol, we emphasize evidence published after the American College of Cardiology/American Heart Association (ACC/AHA)¹ and American College of Physicians (ACP)² guidelines, outline the limitations of the evidence, and suggest clinical approaches. A summary of our review of the evidence is presented in Table 1, and suggested approaches using these data are presented in Table 2 and Figures 1 and 2.

View this table: [in this window] [in a new window]   TABLE 1. Perioperative Cardiac Risk Management: Practices, Evidence, and Recommendations

View this table: [in this window] [in a new window]   TABLE 1. Continued

View this table: [in this window] [in a new window]   TABLE 1. Continued

View this table: [in this window] [in a new window]   TABLE 2. Clinical Factors Important in Assessing Perioperative Cardiac Risk

View larger version (29K): [in this window] [in a new window]   Figure 1. Suggested initial clinical assessment of patients undergoing noncardiac surgery.

View larger version (33K): [in this window] [in a new window]   Figure 2. Additional risk stratification and treatment before noncardiac surgery. Recommendations for risk stratification and cardioprotective approach in patients undergoing noncardiac surgery. ß-Blockade and statin therapy should be considered in all patients with a long-term indication for these drugs. Patients who meet criteria for perioperative ß-blockade but have no long-term indication should have ß-blockers continued at least 7, and optimally 30, days after surgery. *RCRI.9 **Options for noninvasive tests include dipyramidole thallium scintigraphy, sestamibi scintigraphy, or stress echocardiography. Testing should be performed . . . [Full Text of this Article]

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