Preoperative Cardiac Risk Assessment

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Major adverse cardiac events are significant causes of perioperative mortality and morbidity.
• Thorough preoperative risk assessment and postoperative monitoring are crucial for preventing cardiac complications.

Purpose of the Study:

• To review current guidelines and strategies for assessing and managing perioperative cardiac risk.
• To highlight differences in risk assessment approaches between major international guidelines.

Main Methods:

• Review of major American, European, and Canadian guidelines for perioperative cardiac risk assessment.
• Discussion of risk calculators, functional capacity assessment, and biomarker-based strategies.

Main Results:

• Guidelines differ on using functional capacity versus biomarkers (e.g., B-type natriuretic peptide) for guiding postoperative myocardial injury screening.
• Identification of specific conditions (e.g., acute coronary syndrome) that warrant postponing nonemergent surgery.

Conclusions:

• Current guidelines offer varied approaches to perioperative cardiac risk stratification and management.
• The role of biomarkers in guiding interventions for myocardial injury after noncardiac surgery requires further research.