RT Book, Section
A1 Cheng, Hugo Q.
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184156155
T1 Cardiac Risk Assessment & Reduction in Noncardiac Surgery
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184156155
RD 2024/04/23
AB The  most  important  perioperative  cardiac  complications  are  myocardial  infarction  (MI)  and  cardiac  death;  postoperative  myocardial  injury  is  a  major  predictor  of  mortality.  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  cardiovascular  disease.  This  includes  not  only  coronary  artery  disease  and  HF  but  also  cerebrovascular  disease  and  chronic  kidney  disease.  Diabetes  mellitus,  especially  if  treated  with  insulin,  is  considered  a  cardiovascular  disease  equivalent  that  increases  the  risk  of  cardiac  complications.  Major  abdominal,  thoracic,  and  vascular  surgical  procedures  (especially  abdominal  aortic  aneurysm  repair)  carry  a  higher  risk  of  postoperative  cardiac  complications,  likely  due  to  their  associated  major  fluid  shifts,  hemorrhage,  and  hypoxemia.  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.