Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography: Findings From the Mayo Poce-DSE Investigators

Widmer, R. Jay; Cullen, Michael W.; Salonen, Bradley R.; Sundsted, Karna K.; Raslau, David; Mohabbat, Arya B.; Dougan, Brian; Bierle, Dennis M.; Lawson, Donna K.; Widmer, A.; Bundrick, Mary; Tellez, R.; Schroeder, Darrell R.; McCully, Robert B.; Mauck, Karen F.

doi:10.1016/j.amjmed.2017.12.025

Cited by 10 publications

(2 citation statements)

References 8 publications

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“…The prevalence of clinical CAD is around 10% (3) in developed or developing countries, and the incidence and severity of CAD increases with age in both sexes, increasing the frequency of surgeries (4)(5)(6). Thus, the incidence of adverse cardiac events, such as acute myocardial infarction and death from cardiac causes after non-cardiac surgery may reach 3.9%, particularly in major surgeries (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Pre-anesthetic evaluation aims to minimize the risk of perioperative surgical complications, by planning intraoperative trans-care to prevent cardiovascular events associated with hypotension, volume overload, and acute anemia (8). A common practice emerging from these evaluations is the pursuit of the diagnosis of silent coronary disease (screening), motivated by the belief that this would generate cardiovascular protection for patients.…”

Section: Introductionmentioning

confidence: 99%

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Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Oliveira

Santos

Silva

et al. 2021

Braz J Med Biol Res

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Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low-to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing preanesthesia assessment between May 2015 and May 2016, including those with functional capacity X4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47 ± 16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Oliveira

Santos

Silva

et al. 2021

Braz J Med Biol Res

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The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery

Vernooij

Klei

Moons

et al. 2021

Cochrane Database of Systematic Reviews

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Perioperative care of cardiac patient’s candidate for non-cardiac surgery: a critical appraisal of emergent evidence and international guidelines

2018

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The perioperative management of a cardiac-patient candidate to non-cardiac surgery (NCS) remains a topic of considerable debate. In recent years, the overall tendency from professional societies has been to delineate how to identify and manage high-risk patients following the best evidence. However, significant concerns persist, especially in the care of intermediate-risk patients (also labeled at "acceptable" risk), who may not fit into the categories of "completely healthy" or "critically ill", but that might still encounter dramatic (and unexpected) perioperative events. The specific interest and main goal of this expert viewpoint pertains to the care of cardiac patients scheduled for NCS, addressing central questions of real-life clinical care that practicing anesthesiologists and cardiologists face daily, discussing recent American College of Cardiology/American Heart Association (ACC/AHA), European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA), and Canadian Cardiovascular Society (CCS) guidelines. The viewpoint aims to discuss few of the important topics pertaining perioperative assessment and management: type of NCS and perioperative cardiac events, risk prediction including testing, and perioperative management of cardiac therapy. The fact that cardiac adverse events have reduced in number mostly due to better preoperative management and prevention should not prompt a reduction in clinical evaluations. While debate remains pertaining the most appropriate way to evaluate patients for NCS within international societies, a comprehensive approach-evaluation best recognized to assess functional and heart status, should be maintained, keeping into consideration the surgical procedure and global health management.

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Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography: Findings From the Mayo Poce-DSE Investigators

Cited by 10 publications

References 8 publications

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

Inappropriate screening of obstructive coronary artery disease during pre-anesthesia assessment of candidates for non-cardiac surgery

The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery

Perioperative care of cardiac patient’s candidate for non-cardiac surgery: a critical appraisal of emergent evidence and international guidelines

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