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Evaluation of coronary artery disease in patients having noncardiac surgery
1Cardiology Service, Eisenhower Army Medical Center, Fort Gordon, Ga.
Southern Medical Journal
|November 1, 1987
Insights
Perioperative myocardial infarction and cardiac death are serious risks of noncardiac surgery. Further cardiac evaluation with imaging or angiography may be necessary for select patients to define preoperative risk.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiovascular Surgery
Background:
- Noncardiac surgery carries risks of perioperative myocardial infarction and cardiac death.
- Clinical variables are the initial step in preoperative risk assessment.
- Current methods lack a definitive formula for identifying patients needing further cardiac evaluation.
Purpose of the Study:
- To highlight the importance of preoperative risk assessment for noncardiac surgery.
- To discuss the role of advanced cardiac evaluation in selected patients.
Main Methods:
- Review of clinical variables for risk stratification.
- Consideration of thallium scintigraphy for risk assessment.
- Consideration of coronary arteriography for risk assessment.
Main Results:
- Clinical assessment alone is insufficient for all patients.
- Thallium scintigraphy can aid in defining risk in select cases.
- Coronary arteriography provides detailed risk definition in specific patient groups.
Conclusions:
- Perioperative cardiac events are significant concerns in noncardiac surgery.
- Risk assessment requires a nuanced approach beyond basic clinical variables.
- Advanced cardiac imaging and angiography are crucial for selected patients to optimize outcomes.
Abstract:
Perioperative myocardial infarction and cardiac death are feared complications of noncardiac surgery. Preoperative risk assessment begins with clinical variables. There is no formula for determining who needs further evaluation. In selected patients, thallium scintigraphy or coronary arteriography is needed to define preoperative risk.