Update in perioperative cardiac medicine 2021

Abstract

T he choice of calculators to predict perioperative cardiac risk, assessment of a patient's exercise capacity, role of preoperative biomarkers, and need for anticoagulation after postoperative atrial fi brillation are controversial topics in perioperative medicine, and the evidence continues to evolve. This update will highlight new information in these areas based on publications from the past year. ■ CARDIAC RISK CALCULATORSCurrent guidelines 1 recommend the use of either the Revised Cardiac Risk Index, Myocardial Infarction or Cardiac Arrest Calculator, or American College of Surgeons Surgical Risk Calculator to estimate the risk of postoperative cardiac complications. Other calculators designed specifi cally for geriatric patients or for vascular surgery are also available. Most of these tools were developed retrospectively from databases or have not been externally validated. What's new? Two new calculatorsTwo new prospectively developed calculators were recently reported, the American University of Beirut (AUB)-HAS2 Index 2-4 and the Updated Cardiac Risk Score (UCRS). 5The AUB-HAS2 Index Dakik et al 2 prospectively derived the AUB-HAS2 Index from 3,284 adult patients undergoing noncardiac surgery at the American University of Beirut Medical Center and validated it in 1,167,414 patients from the American College of Surgeons National Surgical Quality Improvement Program database. 2 The primary outcome included death, myocardial infarction, or stroke at 30 days after surgery. The index and "HAS2" acronym are based on the following risk factors: