Preoperative Assessment and Management of Cardiovascular Risk in Patients Undergoing Non-Cardiac Surgery: Implementing a Systematic Stepwise Approach during the COVID-19 Pandemic Era.
Eduardo BossoneFilippo CademartiriHani AlSerganiSalvatore ChianeseRahul MehtaValentina CaponeCarlo RuotoloImran Hayat TarrarAntonio FrangiosaOlga VrizVincenzo MaffeiRoberto AnnunziataDomenico GalzeranoBrigida RanieriChiara SepeAntonio CittadiniRosangela CocchiaMassimo MajoloGiuseppe RussoGiuseppe LongoMario MutoPaolo FedeliniCiro EspositoAlessandro PerrellaGianluca GugginoEliana RaiolaMara CatalanoMaurizio De PalmaLuigia RomanoGaetano RomanoCiro CoppolaCiro MauroRajendra H MehtaPublished in: Journal of cardiovascular development and disease (2021)
Major adverse cardiac events, defined as death or myocardial infarction, are common causes of perioperative mortality and major morbidity in patients undergoing non-cardiac surgery. Reduction of perioperative cardiovascular risk in relation to non-cardiac surgery requires a stepwise patient evaluation that integrates clinical risk factors, functional status and the estimated stress of the planned surgical procedure. Major guidelines on preoperative cardiovascular risk assessment recommend to establish, firstly, the risk of surgery per se (low, moderate, high) and the related timing (elective vs. urgent/emergent), evaluate the presence of unstable cardiac conditions or a recent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting), assess the functional capacity of the patient (usually expressed in metabolic equivalents), determine the value of non-invasive and/or invasive cardiovascular testing and then combine these data in estimating perioperative risk for major cardiac adverse events using validated scores (Revised Cardiac Risk Index (RCRI) or National Surgical Quality Improvement Program (NSQIP)). This stepwise approach has the potential to guide clinicians in determining which patients could benefit from cardiovascular therapy and/or coronary artery revascularization before non-cardiac surgery towards decreasing the incidence of perioperative morbidity and mortality. Finally, it should be highlighted that there is a need to implement specific strategies in the 2019 Coronavirus disease (COVID-19) pandemic to minimize the risk of transmission of COVID-19 infection during the preoperative risk assessment process.
Keyphrases
- cardiac surgery
- patients undergoing
- quality improvement
- coronary artery bypass grafting
- percutaneous coronary intervention
- acute kidney injury
- coronary artery disease
- risk assessment
- left ventricular
- risk factors
- coronary artery
- st segment elevation myocardial infarction
- coronavirus disease
- coronary artery bypass
- acute myocardial infarction
- patient safety
- acute coronary syndrome
- end stage renal disease
- st elevation myocardial infarction
- human health
- minimally invasive
- cardiovascular events
- case report
- heart failure
- ejection fraction
- heavy metals
- pulmonary artery
- newly diagnosed
- chronic kidney disease
- palliative care
- high intensity
- peritoneal dialysis
- aortic stenosis
- prognostic factors
- type diabetes
- pulmonary hypertension
- emergency department
- smoking cessation
- deep learning
- machine learning
- bone marrow
- stress induced
- big data