2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management

Abstract

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Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

“…Current guidelines from the American College of Cardiology/American Heart Association advise measuring troponin levels in patients undergoing noncardiac surgery with signs of symptoms of ischemia (Class I recommendation), and both these American College of Cardiology/American Heart Association and the European Society of Cardiology/Heart Association Guidelines give a weak recommendation for routine troponin screening in patients at high risk for perioperative cardiovascular events (Class IIb recommendation) 25, 26. While in our study the hazard of mortality was similar in patients not sampled compared to those who were sampled but below the 99th percentile (<0.01 ng/mL), these results are contrary to strong evidence that in the absence of routine troponin sampling, 85% of prognostically important myocardial injuries after noncardiac surgery may be undetected 3.…”

Cardioorthopedics — is it necessary in clinical practice? A study of patients with hip replacement surgery

“…Primary hip replacement surgery was performed in patients aged 6-106 years; in 50% of cases, the age of the patient was less than 69 years [9]. Orthopaedic surgeries concerning the knee and hip joints are interventions with respectively low (< 1%), and intermediate (1-5%) risk of sudden death or a myocardial infarction within 30 days after treatment, but certain patients may be at high risk [10]. Patients undergoing this surgery are usually elderly with restricted physical activity because of pain in the joints, and as a result are at increased risk of CVD.…”

Prediction Score in Surgical Complications Estimation in the Practice of Internist

“…Prediction score in surgical complications estimation in the practice of internist Kotova D. P. 1,2 , Kotov S. V. 1,2 , Gilyarov M. Yu. 1,3 , Shemenkova V. S. ИМ -инфаркт миокарда, ССО -сердечнососудистые осложнения, ФК -функциональный класс, ЭКГ -электрокардиограмма, HCO 3 -концентрация гидрокарбонатов, PCO 2 -парциальное давление углекислого газа, PO 2 -парциальное давление кислорода, К + -калий, POSSUM -Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity, RCRI -Revised Cardiac Risk Index.…”

“…Было подсчитано, что из ~19 млн оперативных вмешательств, прово-димых за год в Европе, ~30% -это пациенты с сопутствующей патологией сердечно-сосудистой системы, которые в послеоперационном периоде имели осложнения [2]. Сердечная смертность после некардиальных операций по данным литературы составляет от 0,5% до 1,5%, а частота осложнений -от 2% до 3,5% [2,3]. На примере европейской попу-ляции, это >150 тыс.…”

“…По данным литературы люди пожилого возраста подвергаются хирургическим процедурам в 4 раза чаще, чем лица более молодого возраста. При изуче-нии демографических показателей в хирургических отделениях также отмечено увеличение доли пожи-щиеся шкалы можно условно разделить на 2 большие группы: для оценки общего риска осложнений, свя-занных с оперативным вмешательством в целом -POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity), NSQIP (National Surgical Quality Improvement Program database) и для оценки риска развития сердечно-сосудистых событий -Goldman, Detsky, RCRI (Revised Cardiac Risk Index by Lee), Gupta index (MICA -Myocardial Infarction or Cardiac Arrest) [2,4]. Рассмотрим эти индексы более подробно.…”