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J Clin Outcomes Manage
2005 Jun;12(6):317-328
Reducing perioperative cardiac complications in patients undergoing noncardiac surgery
Potyk DK
Program Audience: Primary care physicians Educational Needs Addressed: Cardiac events are common complications of elective noncardiac surgery and increase the mortality and costs associated with these procedures. Recent insight into the pathophysiology of perioperative myocardial ischemia has led to an emphasis on preoperative risk stratification as well as postoperative management. As a result, preoperative cardiac risk evaluation has become an integral part of contemporary clinical practice. Although there is agreement that clinical markers can identify high-risk patients, the approach to risk reduction has been controversial. Good data are becoming available to help guide clinical decision making. Primary care physicians should be able to perform most preoperative cardiac evaluations and recommend risk-reduction strategies without subspecialty referral. To do so, physicians must understand perioperative myocardial ischemia, be familiar with the published guidelines and data in the area of risk assessment, and use an evidence-based approach to risk reduction in high-risk patients. Educational Objectives 1. Recognize the characteristics of perioperative myocardial ischemia and how they relate to postoperative myocardial infarction, 2. Understand the appropriate role of preoperative coronary revascularization, 3. Describe first-line medical therapy for decreasing perioperative cardiac complications, 4. Know second-line and emerging medical therapies for high-risk patients, 5. Understand the value of perioperative pulmonary artery catheterization
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