[Cardiovascular assessment and management prior to non-cardiac surgery. Comment on the new 2014 ESC/ESA guidelines]

In 2014 the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) published an update of the guidelines on "non-cardiac surgery: cardiovascular assessment and management". Epidemiological data underline the relevance of these guidelines: a total of 5.7 million surgical procedures are performed per year in patients with increased cardiac risk and approximately 167,000 cardiac complications occur per year in Europe of which 19,000 are life-threatening. This new version of the guidelines highlights the patient characteristics, such as functional capacity and comorbidities and procedure-specific aspects for perioperative risk stratification. Decision-making for preoperative stress tests and coronary angiography has been simplified, procedure-specific risks have been revised and the role of multidisciplinary teamwork for high risk procedures is emphasized. A standardized stepwise approach on how to stratify patient-specific and procedure-associated risks has been established. For the first time, the guidelines recommend perioperative regimens on dual antiplatelet therapy and the new oral anticoagulants (NOAC).