Preoperative Assessment and Management of Cardiovascular Risk in Patients Undergoing Non-Cardiac Surgery:...

Area of Science:

• Cardiology
• Anesthesiology
• Perioperative Medicine

Background:

• Major adverse cardiac events (MACE) like death and myocardial infarction are significant causes of perioperative mortality and morbidity in patients undergoing non-cardiac surgery.
• Effective perioperative cardiovascular risk reduction necessitates a structured patient evaluation process.

Purpose of the Study:

• To outline a stepwise approach for preoperative cardiovascular risk assessment in patients undergoing non-cardiac surgery.
• To guide clinicians in identifying patients who may benefit from interventions to mitigate perioperative cardiac events.

Main Methods:

• Guidelines recommend a stepwise evaluation: assessing surgical risk (low, moderate, high) and timing (elective/urgent).
• Evaluating for unstable cardiac conditions, recent revascularization (PCI, CABG), and patient functional capacity (metabolic equivalents).
• Utilizing validated scores like Revised Cardiac Risk Index (RCRI) and National Surgical Quality Improvement Program (NSQIP) to estimate MACE risk.

Main Results:

• The stepwise approach integrates clinical factors, functional status, and surgical stress to estimate perioperative cardiac risk.
• This strategy aids in identifying patients who could benefit from preoperative cardiovascular therapy or revascularization.
• Implementation of specific strategies is needed to minimize COVID-19 transmission during preoperative risk assessment.

Conclusions:

• A systematic, stepwise preoperative cardiovascular risk assessment is crucial for managing patients undergoing non-cardiac surgery.
• This approach helps optimize patient selection for interventions, potentially reducing perioperative morbidity and mortality.
• Adapting risk assessment protocols to address pandemic-related concerns, such as COVID-19 transmission, is essential.