Preoperative cardiac risk assessment - An updated approach

Hypothesis: We provide an updated algorithm for approaching preoperative ca rdiac risk assessment in patients undergoing noncardiac surgery. Design: A National Library of Medicine PubMed literature search was perform ed dating back to 1985 using the keywords "preoperative cardiac risk for no ncardiac surgery." This search was restricted to English language articles involving human subjects. Results: Patient-specific and operation-specific cardiac risk can be determ ined clinically. Patients with major cardiac risk factors have a high incid ence of perioperative cardiac complications, whereas the risk is less than 3% for low-risk patients. For intermediate-risk patients, no prospective ra ndomized studies demonstrate the efficacy of noninvasive stress testing (di pridamole thallium or dobutamine echocardiography) or of subsequent coronar y revascularization for preventing perioperative cardiac complications. Rec ent studies demonstrate that perioperative beta -blockade significantly red uces the adverse cardiac event rate in intermediate-risk patients. Conclusions: Most patients with high cardiac risk should proceed with coron ary angiography. Patients with low cardiac risk can proceed to surgery with out noninvasive testing. For intermediate risk patients, consideration may be given to further stress testing prior to surgery; however, in most patie nts, proceeding to surgery with perioperative beta -blockade is an acceptab le alternative.