Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

By P. Devereaux, L. Goldman, D. A. Cook, Ken Gilbert, K. Leslie, G. Guyatt. Canadian Medical Association Journal, 2005

649 citations recorded by the source corpus.

THIS IS THE FIRST OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. In this article, we review the magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk. The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500 000 to 900 000 of these patients experience perioperative cardiac death, nonfatal myocardial infarction (MI) or nonfatal cardiac arrest. Although the evidence is limited, a substantial proportion of fatal perioperative MIs may not share the same pathophysiology as nonoperative MIs. A clearer understanding of the pathophysiology is needed to direct future research evaluating prophylactic, acute and long-term interventions. Researchers have developed tools to facilitate the estimation of perioperative cardiac risk. Studies suggest that the Lee index is the most accurate generic perioperative cardiac risk index. The limitations of the studies evaluating the ability of noninvasive cardiac tests to predict perioperative cardiac risk reveals considerable uncertainty as to the role of these popular tests. Similarly, there is uncertainty as to the predictive accuracy of the American College of Cardiology / American Heart Association algorithm for cardiac risk assessment. Patients are likely to benefit from improved estimation and communication of cardiac risk because the majority of noncardiac surgeries are elective and accurate risk estimation is important to allow informed patient and physician decision-making.

Subfields: Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/8a55f9db9d842e192a314d234cb4e159fa24a7b7

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

1. Emmanuelle Duceppe
2. C. Ko
3. W. Chow
4. R. Merkow
5. Amal Bessissow
6. K. Lyons
7. P. Macdonald
8. Kim Styles

Citations in the corpus

• Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. (2012, background): “9% for patients with or at risk of cardiac isease.(51) The rates exceed 5% for high-risk cardiac patients.”
• Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. (2017, background): “13,26 The likely explanation for these differences is that the original RCRI study monitored creatine kinase muscle and brain isoenzyme and excluded emergency surgery patients, whereas the external validation studies monitored troponin measurements that are much more sensitive than creatine kinase…”
• Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data (2009, neutral): “Although this is suggested by our meta-regression showing a beneficial effect in patients admitted to surgical ICUs, subgroup analyses must be interpreted with caution, particularly in the setting of low event rates.(44,45) In the surgical ICU subgroup, there were only 77 deaths in the intensive ins”