Preoperative strategies to assess cardiac risk before noncardiac surgery

Abstract

Summary:The strategies recommended in the preoperative cardiac risk assessment prior to major vascular and nonvascular surgery are reviewed. The role of clinical evaluation, noninvasive stress testing (exercise test, stress myocardial perfusion imaging, stress echocardiography), and Holter monitoring during the preoperative evaluation are outlined and the value of intervention based on the use of each test is discussed. Recommended strategies to evaluate patients based on their clinical risk markers in addition to the results of the noninvasive risk assessment are presented.

Guidelines for perioperative cardiac evaluation from the American College of Cardiology/American Heart Association task force are effective for stratifying cardiac risk before aortic surgery

“…Numerous attempts to define a strategy for preoperative cardiac evaluation have been made in the last few years, reflecting the lack of consensus among the different teams. 4,12,19,[38][39][40][41][42][43] This diversity may also reflect the challenge to physicians of trying to implement guidelines. 44 Several authors have shown that no single implementation strategy is appropriate; each strategy is influenced by the person using the guidelines, by the incentive system, and by the guidelines' content.…”

Review: Managing the diabetic patient with angina

“…These include diabetic patients needing renal transplantation or major non-cardiac vascular surgery in whom coronary revascularisation may reduce the procedural risk. [14][15][16] Anti-anginal drugs…”