Predicting cardiac risk in noncardiac surgery: a narrative review

Faloye, Abimbola; Gebre, Melat; Bechtel, Allison J.

doi:10.1007/s00540-020-02868-7

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…230,238 d Ischaemic heart disease, cerebrovascular disease, renal insufficiency, or diabetes mellitus, according to the RCRI score. 239 e Treatment should ideally be initiated between 30 and (at least) 2 days before surgery, starting at a low dose, and should be continued post-operatively. 197,230,237 240 The trial randomized 10 010 patients undergoing NCS with established CVD, or who were at increased CV risk, to aspirin or placebo.…”

Section: Iia Cmentioning

confidence: 99%

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Halvorsen¹,

Mehilli²,

Cassese³

et al. 2022

European Heart Journal

444

200

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All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the guidelines. The report is also available on the ESC website www.escardio.org/Guidelines See the European Heart Journal online for supplementary data that include background information and detailed discussion of the data that have provided the basis of the guidelines.Click here to access the corresponding ESC CardioMed chapters.

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Section: Iia Cmentioning

confidence: 99%

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Halvorsen¹,

Mehilli²,

Cassese³

et al. 2022

European Heart Journal

444

200

View full text Add to dashboard Cite

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“…The RCRI has been widely used to predict perioperative cardiac complications [ 10 – 14 ]. In external validation studies, the RCRI showed moderate discriminatory capacity and high negative predictive value in noncardiac surgery patients [ 41 – 43 ]. However, it underestimates the risk of major adverse cardiac events [ 42 – 44 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting perioperative myocardial injury/infarction after noncardiac surgery in patients under surgical and medical co-management: a prospective cohort study

Xi,

Wang,

et al. 2024

BMC Geriatr

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Background Perioperative myocardial injury/infarction (PMI) following noncardiac surgery is a frequent cardiac complication. This study aims to evaluate PMI risk and explore preoperative assessment tools of PMI in patients at increased cardiovascular (CV) risk who underwent noncardiac surgery under the surgical and medical co-management (SMC) model. Methods A prospective cohort study that included consecutive patients at increased CV risk who underwent intermediate- or high-risk noncardiac surgery at the Second Medical Center, Chinese PLA General Hospital, between January 2017 and December 2022. All patients were treated with perioperative management by the SMC team. The SMC model was initiated when surgical intervention was indicated and throughout the entire perioperative period. The incidence, risk factors, and impact of PMI on 30-day mortality were analyzed. The ability of the Revised Cardiac Risk Index (RCRI), frailty, and their combination to predict PMI was evaluated. Results 613 eligible patients (mean [standard deviation, SD] age 73.3[10.9] years, 94.6% male) were recruited consecutively. Under SMC, PMI occurred in 24/613 patients (3.9%). Patients with PMI had a higher rate of 30-day mortality than patients without PMI (29.2% vs. 0.7%, p = 0.00). The FRAIL Scale for frailty was independently associated with an increased risk for PMI (odds ratio = 5.91; 95% confidence interval [CI], 2.34–14.93; p = 0.00). The RCRI demonstrated adequate discriminatory capacity for predicting PMI (area under the curve [AUC], 0.78; 95% CI, 0.67–0.88). Combining frailty with the RCRI further increased the accuracy of predicting PMI (AUC, 0.87; 95% CI, 0.81–0.93). Conclusions The incidence of PMI was relatively low in high CV risk patients undergoing intermediate- or high-risk noncardiac surgery under SMC. The RCRI adequately predicted PMI. Combining frailty with the RCRI further increased the accuracy of PMI predictions, achieving excellent discriminatory capacity. These findings may aid personalized evaluation and management of high-risk patients who undergo intermediate- or high-risk noncardiac surgery.

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“…Especially, measuring hs-cTn can detect slight myocardial injury in the acute phase ( 2 , 3 ). Instead, NT-proBNP would be useful to evaluate prognosis and cardiac risk in non-cardiac surgery ( 29 ). Generally, ANP is not used in evaluation for PMI, while in cats there is no research on perioperative changes in ANP in cats.…”

Section: Discussionmentioning

confidence: 99%

Perioperative changes in cardiac biomarkers in juvenile cats during neutering

Konishi¹,

Sakamoto²,

Satake³

et al. 2022

Front. Vet. Sci.

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Perioperative myocardial injury (PMI) is commonly caused by myocardial ischemia that develops during or after non-cardiac surgery. It occurs in 17.9% of human patients after non-cardiac surgery due to elevated high-sensitive perioperation cardiac troponin. However, PMI has not been demonstrated in cats. To investigate its occurrence, this study aimed to analyze the perioperative changes in cardiac biomarkers and clinical data, including measurement of vital signs, echocardiography, blood pressure, electrocardiogram, X-ray, and anesthetic profile, in 30 juvenile cats under neutering surgery. All cats had increased high-sensitive cardiac troponin I (hs-cTnI) postsurgery compared with presurgery. In particular, 48% of cats (14/29) showed elevated hs-cTnI over a reference range after surgery. In all groups, hs-cTnI and systolic arterial blood pressure (SAP) were significantly higher at 0 h and 18 h postoperation than at preoperation. A significant positive correlation was found between hs-cTnI and SAP at 18 h postoperation. Atrial natriuretic peptides, heart rate, and left ventricular wall thickness were markedly higher at 0 h postoperation than at preoperation; however, respiratory rate and body temperature were significantly lower at 0 h postoperation than at preoperation. Anesthetic time and hs-cTnI were significantly higher at 18 h postoperation in females than in males. Significant positive correlations were observed between hs-cTnI and anesthetic time at 18 h postoperation in females. These results indicate that postoperative hs-cTnI level can greatly increase in juvenile cats and hs-cTnI measurement at perioperation is potentially beneficial for early detection and evaluation of the presence of PMI.

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Predicting cardiac risk in noncardiac surgery: a narrative review

Cited by 4 publications

References 19 publications

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Predicting perioperative myocardial injury/infarction after noncardiac surgery in patients under surgical and medical co-management: a prospective cohort study

Perioperative changes in cardiac biomarkers in juvenile cats during neutering

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