TY - CHAP M1 - Book, Section TI - Cardiac Risk Assessment & Reduction in Noncardiac Surgery A1 - Cheng, Hugo Q. A2 - Papadakis, Maxine A. A2 - McPhee, Stephen J. A2 - Rabow, Michael W. A2 - McQuaid, Kenneth R. PY - 2023 T2 - Current Medical Diagnosis & Treatment 2023 AB - The most important perioperative cardiac complications are MI and cardiac death. Other complications include heart failure (HF), arrhythmias, and unstable angina. The principal patient-specific risk factor for cardiac complications is the presence of end-organ CVD. This includes not only CAD and HF but also CVD and CKD. Diabetes mellitus, especially if treated with insulin, is considered a CVD equivalent that increases the risk of cardiac complications. Major abdominal, thoracic, and vascular surgical procedures (especially AAA repair) carry a higher risk of postoperative cardiac complications. These risk factors were identified in a validated, multifactorial risk prediction tool: the Revised Cardiac Risk Index (RCRI) (Table 3–2). The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) risk prediction tool uses patient age, the location or type of operation, serum creatinine greater than 1.5 mg/dL (132.6 mcmol/L), dependency in activities of daily living, and the patient’s American Society of Anesthesiologists physical status classification as predictors for postoperative MI or cardiac arrest. An online risk calculator using the NSQIP tool can be found at https://qxmd.com/calculate/calculator_245/gupta-perioperative-cardiac-risk. The American College of Cardiology and American Heart Association endorse both prediction tools. Patients with two or more RCRI predictors or a risk of perioperative MI or cardiac arrest in excess of 1% as calculated by the NSQIP prediction tool are deemed to be at elevated risk for cardiac complications. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1193124416 ER -