J Clin Outcomes Manage
Preoperative cardiac evaluation for noncardiac surgery; a critical review
Taqui BS, McNellis K, Coppola K, Shishodia H, Defrancesch G, Van den Berg-Wolf MG, Kaplan LI, Moyer DV
Abstract Objective: To review preoperative cardiac risk stratification and management in patients undergoing noncardiac surgery. Methods: Review of the literature, with a focus on the 2007 American College of Cardiology/American Heart Association guidelines and landmark papers. Results: The updated guidelines emphasize preoperative clinical risk stratification and deemphasize routine preoperative cardiac testing in patients with known or suspected coronary disease. Most patients without active cardiovascular conditions who are not at very high risk can proceed to surgery without further testing. Use of preoperative noninvasive testing is warranted in selected very high-risk patients and/or if the results will change patient management. Beta-Blocker therapy is reasonable in higher-risk patients. However, the updated guidelines do not include data from the POISE trial, the results of which call into question the routine initiation of prophylactic preoperative Beta blockade. There is ongoing research concerning preoperative statin therapy, which appears to be beneficial, especially in vascular surgery patients. A notable change in the guidelines reflects recent evidence that intermediate-risk patients might not benefit from prophylactic preoperative revascularization. Conclusion: An individualized multidisciplinary approach and risk-benefit discussion with each patient is the most prudent path to ensuring success.
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