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(Circulation. 2008;117:3134-3144.)
© 2008 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Are the current perioperative risk management strategies for myocardial infarction flawed?

Current Guideline-Based Preoperative Evaluation Provides the Best Management of Patients Undergoing Noncardiac Surgery

Gabriel Gregoratos, AB, MD

From the University of California at San Francisco.

Correspondence to Gabriel Gregoratos, AB, MD, 505 Parnassus Ave, M-314, Box 0214, San Francisco, CA 94143–0214. E-mail gpggrego@medicine.ucsf.edu

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

	Introduction

 
This report will review the 2007 revision of the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery,¹ examine the rationale of the recommendations put forth, and attempt to clarify certain recommendations in the context of optimal patient care.

Response by Brett p 3144

	The Problem

 
The volume of noncardiac surgery has progressively increased over the past 2 decades² to levels exceeding prior predictions,³ with elderly patients undergoing at least 4 million major noncardiac operations annually.⁴ Given the high prevalence of coronary heart disease (CHD), it is not surprising that cardiac complications are a major cause of perioperative morbidity and mortality. Cardiac complications occur in 1% to 5% of unselected patients undergoing vascular surgery.^3,5 Of the 27 million patients undergoing anesthesia annually, 50 000 suffer a perioperative myocardial infarction (MI).⁶ The recently published universal definition of MI⁷ has broadened the definition of MI and will likely result in a further increase of perioperatively diagnosed MIs and affect long-term management and prognosis.⁸ As a result, consultations for preoperative evaluation and assistance in perioperative management are frequently requested of cardiologists, internists, and generalists by surgeons and anesthesiologists. The guidelines emphasize that the consultant should not only offer opinions regarding the operative risk and advice on perioperative management but should use this opportunity to recommend treatments that will affect long-term patient outcomes.

This report will focus entirely on preoperative risk assessment and management of patients with known or potential CHD, the major cause of perioperative cardiac . . . [Full Text of this Article]

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