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Use and Misuse of Preoperative Cardiac Testing for Noncardiac Surgery

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Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.
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Abstract

Perioperative cardiac morbidity and mortality are of substantial medical and economic concern. Thus, the primary goal of effective perioperative management is to implement strategies that reliably improve outcome. It is the (as yet unproven) premise that preoperative risk stratification based on the results of preoperative cardiac testing is one of such measures that will improve cardiac outcome, due to the modifying effects it can have on overall perioperative management.

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References

  1. Grayburn PA, Hillis LD (2003) Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Ann Intern Med 138:506–511

    PubMed  Google Scholar 

  2. Ridley S (2003) Cardiac scoring systems — what is their value? Anaesthesia 58:985–991

    Article  PubMed  CAS  Google Scholar 

  3. Chassot PG, Delabays A, Spahn DR (2002) Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. Br J Anaesth 89:747–759

    Article  PubMed  Google Scholar 

  4. Fagan TJ (1975) Nomogram for Bayes’ theorem. N Engl J Med 293:257

    PubMed  CAS  Google Scholar 

  5. Eagle KA, Berger PB, Calkins H et al (2002) ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery — Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 105:1257–1267

    PubMed  Google Scholar 

  6. Falcone RA, Nass C, Jermyn R et al (2003) The value of preoperative pharmacologic stress testing before vascular surgery using ACC/AHA guidelines: a prospective, randomized trial. J Cardiothorac Vasc Anesth 17:694–698

    Article  PubMed  Google Scholar 

  7. Mason JJ, Owens DK, Harris RA et al (1995) The role of coronary angiography and coronary revascularization before noncardiac surgery. JAMA 273:1919–1925

    Article  PubMed  CAS  Google Scholar 

  8. McFalls EO, Ward HB, Moritz TE et al (2004) Coronary-artery revascularization before elective major vascular surgery. N Engl J Med 351:2795–2804

    Article  PubMed  CAS  Google Scholar 

  9. Spahn DR, Howell SJ, Delabays A et al (2006) Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. Br J Anaesth 96:675–677

    Article  PubMed  CAS  Google Scholar 

  10. Kertai MD, Bogar L, Gal J, Poldermans D (2006) Pre-operative coronary revascularization: an optimal therapy for high-risk vascular surgery patients? Acta Anaesthesiol Scand 50:816–827

    Article  PubMed  CAS  Google Scholar 

  11. Vicenzi MN, Meislitzer B, Heitzinger B et al (2006) Coronary artery stenting and non-cardiac surgery — a prospective outcome study. Br J Anaesth 96:686–693

    Article  PubMed  CAS  Google Scholar 

  12. De Souza DG, Baum VC, Ballert NM (2007) Late thrombosis of a drug-eluting stent presenting in the perioperative period. Anesthesiology 106:1057–1059

    Article  PubMed  Google Scholar 

  13. Poldermans D, Shouten O, Vidakovic R et al (2007) A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery. The DECREASE-V pilot study. J Am Coll Cardiol 49:1763–1769

    Article  PubMed  Google Scholar 

  14. Hoeks SE, Bax JJ, Poldermans D (2007) Indications of prophylactic coronary revascularization in patients undergoing major vascular surgery: the saga continues. Eur Heart J 28:519–521

    Article  PubMed  Google Scholar 

  15. Kersten JR, Fleisher LA (2007) Drug-eluting coronary stents. What are the risks? Anesthesiology 106:898–900

    Article  PubMed  Google Scholar 

  16. Smith SC Jr, Feldman TE, Hirshfeld JW Jr et al (2006) ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 47:216–235

    Article  PubMed  Google Scholar 

  17. Fox K, Garcia MAA, Ardissino D et al (2006) Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 27:1341–1381

    Article  PubMed  Google Scholar 

  18. Palda VA, Detsky AS, American College of Physicians (1997) Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. Clinical Guideline, Part I. Ann Intern Med 127:309–312

    Google Scholar 

  19. Palda VA, Detsky AS (1997) Perioperative assessment and management of risk from coronary artery disease. Clinical Guideline, Part II. Ann Intern Med 127:313–328

    CAS  Google Scholar 

  20. Priebe H-J (2005) Perioperative myocardial infarction — aetiology and prevention. Br J Anaesth 95:3–9

    Article  PubMed  Google Scholar 

  21. Kertai MD, Bogar L, Poldermans D (2006) Pre-operative coronary revascularization: an optimal therapy for high-risk vascular surgery patients? Acta Anaesthesiol Scand 50:816–827

    Article  PubMed  CAS  Google Scholar 

  22. Cohn SL, Goldman L (2003) Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Med Clin N Am 87:111–136

    Article  PubMed  Google Scholar 

  23. Mukherjee D, Eagle KA (2003) Perioperative cardiac assessment for noncardiac surgery: eight steps to the best possible outcome. Circulation 107:2771–2774

    Article  PubMed  Google Scholar 

  24. Henke PK, Blackburn S, Proctor MC et al (2004) Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are under-prescribed cardioprotective medications: effect on graft patency, limb salvage, and mortality. J Vasc Surg 39:357–365

    Article  PubMed  Google Scholar 

  25. Wesorick DH, Eagle KA (2005) The preoperative cardiovascular evaluation of the intermediate-risk patient: new data, changing strategies. Am J Med 118:1413.e1–9

    Article  Google Scholar 

  26. Poldermans D, Bax JJ, Schouten O et al (2006) Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving betablocker therapy with tight heart rate control? J Am Coll Cardiol 48:984–989

    Article  CAS  Google Scholar 

  27. Eagle KA, Lau WC (2006) Any need for preoperative cardiac testingin intermediate-risk patients with tight beta-adrenergic blockade? J Am Coll Cardiol 48:970–972

    Article  PubMed  Google Scholar 

  28. Auerbach A, Goldman L (2006) Assessing and reducing cardiac risk of noncardiac surgery. Circulation 113:1361–1376

    Article  PubMed  Google Scholar 

  29. Durazzo AES, Machado FS, Ikeoka DT et al (2004) Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 39:967–976

    Article  PubMed  Google Scholar 

  30. Kennedy J, Quan H, Buchan AM et al (2005) Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke 36:2072–2076

    Article  PubMed  CAS  Google Scholar 

  31. McGirt MJ, Perler BA, Brooke BS et al (2005) 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg 42:829–836

    Article  PubMed  Google Scholar 

  32. O’Neil-Callahan K, Katsimaglis G, Tepper MR et al (2005) Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery. J Am Coll Cardiol 45:336–342

    Article  PubMed  CAS  Google Scholar 

  33. Shouten O, Kertai MD, Bax JJ et al (2005) Safety of perioperative statin use in high-risk patients undergoing major vascular surgery. Am J Cardiol 95:658–660

    Article  CAS  Google Scholar 

  34. Ward RP, Leeper NJ, Kirkpatrick JN et al (2005) The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. Int J Cardiol 104:264–268

    Article  PubMed  Google Scholar 

  35. Boushra NN, Muntazar M (2006) Review article: the role of statins in reducing perioperative cardiac risk: physiologic and clinical perspectives. Can J Anesth 53:1126–1147

    Article  PubMed  Google Scholar 

  36. Kapoor AS, Kanji H, Buckingham J et al (2006) Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ 333:1149

    Article  PubMed  CAS  Google Scholar 

  37. Hindler K, Shaw A, Samuels J et al (2006) Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 105:1260–1272

    Article  PubMed  CAS  Google Scholar 

  38. Kersten JR, Fleisher LA (2006) Statins. The next advance in cardioprotection? Anesthesiology 105:1079–1080

    Article  PubMed  Google Scholar 

  39. Mangano DT, for the Multicenter Study of Perioperative Ischemia Research Group (2002) Aspirin and mortality from coronary bypass surgery. N Engl J Med 347:1309–1317

    Google Scholar 

  40. Boersma E, Poldermans D, Bax JJ et al, for the DECREASE Study Group (2001) Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 285:1865–1873

    Google Scholar 

  41. London MJ, Zaugg M, Schaub MC et al (2004) Perioperative ß-adrenergic receptor blockade. Physiologic foundations and clinical controversies. Anesthesiology 100:170–175

    Article  PubMed  Google Scholar 

  42. Lindenauer PK, Pekow P, Wang K et al (2005) Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353:349–361

    Article  PubMed  CAS  Google Scholar 

  43. Van de Pol MA, Van Houdenhoven M, Hans EW et al (2006) Influence of cardiac risk factors and medication on length of hospitalization in patients undergoing major vascular surgery. Am J Cardiol 97:1423–1426

    Article  PubMed  Google Scholar 

  44. Boden WE, O’Rourke RA, Teo KK et al (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516

    Article  PubMed  CAS  Google Scholar 

  45. Nishina K, Mikawa K, Uesugi T et al (2002) Efficacy of clonidine for prevention of perioperative myocardial ischemia: a critical appraisal and meta-analysis of the literature. Anesthesiology 96:323–329

    Article  PubMed  CAS  Google Scholar 

  46. Wallace AW, Galindez D, Salahieh A et al (2004) Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology 101:284–293

    Article  PubMed  CAS  Google Scholar 

  47. Wijeysundera DN, Naik JS, Beattie S (2003) Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med 114:742–752

    Article  PubMed  CAS  Google Scholar 

  48. Legner VJ, Doerner D, McCormick WC et al (2006) Clinician agreement with perioperative cardiovascular evaluation guidelines and clinical outcomes. Am J Cardiol 97:118–122

    Article  PubMed  Google Scholar 

  49. Auerbach DA, Goldman L (2002) β-Blockers and reduction of cardiac events in noncardiac surgery. Scientific review. JAMA 287:1435–1444

    Article  PubMed  CAS  Google Scholar 

  50. Cohn SL, Goldman L (2003) Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Med Clin N Am 87:111–136

    Article  PubMed  Google Scholar 

  51. Feringa HHH, Bax JJ, Boersma E et al (2006) High-dose ß-blockers and tight heart rate control reduce myocardial ischemia and troponin release in vascular surgery patients. Circulation 114[suppl 1]: I–344–349

    Google Scholar 

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© 2008 Springer-Verlag Italia

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Priebe, HJ. (2008). Use and Misuse of Preoperative Cardiac Testing for Noncardiac Surgery. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-0773-4_25

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  • DOI: https://doi.org/10.1007/978-88-470-0773-4_25

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0772-7

  • Online ISBN: 978-88-470-0773-4

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