Skip to main content
SpringerLink
Log in

Preoperative Cardiovascular Risk Assessment

  • Chapter
  • First Online:
Perioperative Management of Patients with Rheumatic Disease

  • 1476 Accesses

Abstract

The contribution of cardiac disease, especially ischemic heart disease, to the risk of noncardiac surgery cannot be overstated. The literature pertaining to the evaluation and treatment of patients with cardiac conditions in the perioperative setting is by far the most investigated and developed domain of perioperative medicine. This association has spawned consensus statements that guide best medical practice “as reported by Fleisher et al. (J Am Coll Cardiol 50:e159–242, 2007) and is a major consideration in professional societies devoted to this clinical domain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2007;50:e159–242.

    Article  PubMed  Google Scholar 

  2. Han C, Robinson DW, Hackett MV, et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167–72.

    PubMed  Google Scholar 

  3. Avina-Zubieta JA, Choi HK, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59(12):1690–7.

    Article  PubMed  Google Scholar 

  4. Chung CP, Oeser A, Avalos I, et al. Utility of the Framingham risk score to predict the presence of coronary atherosclerosis in patients with rheumatoid arthritis. Arthritis Res Ther. 2006;8(6):1–7.

    Article  Google Scholar 

  5. Manzi S, Wasko MC. Inflammation-mediated rheumatic diseases and atherosclerosis. Ann Rheum Dis. 2000;59:321–5.

    Article  PubMed  CAS  Google Scholar 

  6. Fischer LM, Schlienger RG, Matter C, et al. Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am J Cardiol. 2004;93:198–200.

    Article  PubMed  Google Scholar 

  7. Hak AE, Karlson EW, Feskanich D, et al. Systemic lupus erythematosus and the risk of cardiovascular disease: results for the Nurses’ health study. Arthritis Rheum. 2009;61(10):1396–402.

    Article  PubMed  Google Scholar 

  8. Roman MJ, Crow MK, Lockshin MD, et al. Rate and determinants of progression of atherosclerosis in ­systemic lupus erythematosus. Arthritis Rheum. 2007;56(10):3412–9.

    Article  PubMed  CAS  Google Scholar 

  9. Roman MJ, Shanker BA, Davis A, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Eng J Med. 2003;349:2399–406.

    Article  CAS  Google Scholar 

  10. Asanuma Y, Oeser A, Shintani AK, et al. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Eng J Med. 2003;349:2407–15.

    Article  CAS  Google Scholar 

  11. Manzi S, Selzer F, Sutton-Tyrrell K, et al. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum. 1999;42(1):51–60.

    Article  PubMed  CAS  Google Scholar 

  12. Manzi S, Meilahn EH, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in woman with systemic lupus erythematosus: comparison with the Framingham study. Am J Epidemiol. 1997;145(5):408–15.

    Article  PubMed  CAS  Google Scholar 

  13. Ross R. Atherosclerosis-an inflammatory disease. N Eng J Med. 1999;340(2):115–26.

    Article  CAS  Google Scholar 

  14. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.

    Article  PubMed  CAS  Google Scholar 

  15. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Eng J Med. 2005;352:1685–95.

    Article  CAS  Google Scholar 

  16. Urban MK, Jules-Elysee KM, Beckman JB, et al. Pulmonary injury in patients undergoing complex spine surgery. Spine J. 2005;5:269–76.

    Article  PubMed  Google Scholar 

  17. Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005;52:402–11.

    Article  PubMed  Google Scholar 

  18. Ridker PM, Cushman CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in woman. N Eng J Med. 2000;342:836–43.

    Article  CAS  Google Scholar 

  19. Ridker PM, Rifai N, Stampfer MJ, et al. Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation. 2000;101:1767–72.

    Article  PubMed  CAS  Google Scholar 

  20. Harris TB, Ferrucci L, Tracy RP, et al. Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med. 1999;106:506–12.

    Article  PubMed  CAS  Google Scholar 

  21. Ridker PM, Rifai N, Pfeffer M, et al. Elevation of tumor necrosis factor-α and increased risk of recurrent coronary events after myocardial infarction. Circulation. 2000;101:2149–53.

    Article  PubMed  CAS  Google Scholar 

  22. Shoenfeld Y, Gerli R, Doria A, et al. Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation. 2005;112:3337–47.

    Article  PubMed  Google Scholar 

  23. Urowitz MB, Bookman AA, Koehler BE, et al. Am J Med. 1976;60:221–5.

    Article  PubMed  CAS  Google Scholar 

  24. del Rincon ID, Williams K, Stern MP, et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44:2727–45.

    Google Scholar 

  25. Solomon DH, Karlson EW, Rimm EB, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107:1303–7.

    Article  PubMed  Google Scholar 

  26. Wolfe F, Michaud K. The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial infarction predictors in rheumatoid arthritis. Arthritis Rheum. 2008;58:2612–21.

    Article  PubMed  Google Scholar 

  27. Gabriel SE, Crowson CS, O’Fallon WM. Comorbidity in arthritis. J Rheumatol. 1999;26:2475–9.

    PubMed  CAS  Google Scholar 

  28. del Rincon I, Freeman GL, Haas RW, et al. Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis. Arthritis Rheum. 2005;52:3413–23.

    Article  PubMed  Google Scholar 

  29. Urowitz MB, Ibanez D, Gladman DD. Athersclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol. 2007;34:70–5.

    PubMed  Google Scholar 

  30. Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44:2331–7.

    Article  PubMed  CAS  Google Scholar 

  31. Petri M, Perez-Gutthann S, Spence D, et al. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med. 1992;93:513–9.

    Article  PubMed  CAS  Google Scholar 

  32. Manoussakis MN, Georgopoulou C, Zintzaras E, et al. Sjogren’s syndrome associated with SLE: clinical and laboratory profiles and comparison with primary SS. Arthritis Rheum. 2004;50:882–91.

    Article  PubMed  Google Scholar 

  33. Mantilla CB, Horlocker TT, Schroeder DR. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–6.

    Article  PubMed  Google Scholar 

  34. Parviz J, Keshavarzi NR, et al. Revision total hip arthroplasty in octogenarians. A case control study. J Bone Joint Surg. 2007;89:2612–8.

    Article  Google Scholar 

  35. Zhan C, Kaczmarek R, Layo-Berrios N, et al. Incidence and short-term outcome of primary and revision hip replacements in the United States. J Bone Joint Surg. 2007;89:526–33.

    Article  PubMed  Google Scholar 

  36. Urban MK, Jules-Elysee K, Loughlin C et al. The one-year incidence of postoperative myocardial infarction in an orthopedic population. HSS Jour 2008;4(1):76–80.

    Google Scholar 

  37. Pioli G, Barone A, Oliveri M, et al. Predictors of mortality after hip fracture: results from 1-year follow-up. Aging Clin Exp Res. 2006;5:381–7.

    Google Scholar 

  38. Lawrence VA, Hilslenbeck SG, Noveck H, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;14(1620):2053–7.

    Article  Google Scholar 

  39. Cloyd JM, Acosta FL, Ames CP. Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. JAGS. 2008;56:1318–27.

    Article  Google Scholar 

  40. Lee TH, Marccantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  PubMed  CAS  Google Scholar 

  41. Devereaux PI, Yang H, Yusef S, et al. Effects of extended release metoprolol succinate in patients undergoing noncardiac surgery (POISE Trial): A randomized control trial. Lancet. 2008;371:1839–47.

    Article  PubMed  CAS  Google Scholar 

  42. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Eng J Med. 1977;297:845–50.

    Article  CAS  Google Scholar 

  43. Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med. 1986;1:211–9.

    Article  PubMed  CAS  Google Scholar 

  44. Boersma E, Kertai MD, Schouten O, et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med. 2005;118:1134–41.

    Article  PubMed  Google Scholar 

  45. Lawrence VA, Hilsenbeck SG, Noveck H, et al. Medical complications and outcomes after hip fracture repair. Arch Intern Med. 2002;14(162):2053–7.

    Article  Google Scholar 

  46. Sinatra RS, Torres J, Bustos AM. Pain management after major orthopedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10:117–29.

    PubMed  Google Scholar 

  47. Kertai MD, Boersma E, Bax BJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart. 2003;89:1327–34.

    Article  PubMed  CAS  Google Scholar 

  48. Etchells E, Meade M, Tomlinson G, et al. Semiquantitative dipyridamole myocardial stress perfusion imaging for cardiac risk assessment before noncardiac vascular surgery: a metaanalysis. J Vasc Surg. 2002;36:535–40.

    Article  Google Scholar 

  49. Salerno Sm, Carlson DW, Soh EK, Lettieri CJ. Impact of perioperative cardiac assessment guidelines on management of orthopedic surgery patients. Am J Med. 2007;120:185e1–6.

    Article  Google Scholar 

  50. Poldermans D, Bax JJ, Schoufen O, et al. Dutch echocardiographic cardiac risk evaluation applying stress echo study group. J Am Coll Cardiol. 2006;48:964–9.

    Article  PubMed  CAS  Google Scholar 

  51. Eagle KA, Rihai CS, Mickel MC, et al. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3368 operations. Circulation. 1997;96:1882–7.

    Article  PubMed  CAS  Google Scholar 

  52. McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Eng J Med. 2004;351:2795–804.

    Article  CAS  Google Scholar 

  53. Vicenzi MN, Meislitzer T, Heitzinger B, et al. Coronary artery stenting and noncardiac surgery –-a prospective outcome study. Br J Anaesth. 2006;96:686–93.

    Article  PubMed  CAS  Google Scholar 

  54. Biondi-Zoccai GC, Agostoni P, Abbate A, et al. Adjusted indirect comparison of intracoronary drug eluting sten: evidence for a metaanalysis of randomized bare metal stent controlled trials. Int J Cardiol. 2005;100:119–23.

    Article  PubMed  Google Scholar 

  55. Spahn Dr, Howell SJ, Delabays A, et al. Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. Br J Anaesth. 2006;96:675–7.

    Article  PubMed  CAS  Google Scholar 

  56. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AJA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Writing Committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). Circulation 2007;116 (17):1971–1996.

    Google Scholar 

  57. Raby KE, Brull SJ, Yimimi F, et al. The effect of heart rate on myocardial ischemia among high-risk patients after vascular surgery. Anesth Anal. 1999;88:477–82.

    CAS  Google Scholar 

  58. Urban MK, Markowitz SM, Gordon MA, et al. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg. 2000;90:1257–61.

    Article  PubMed  CAS  Google Scholar 

  59. Fleischer LA, Beckman JA, Brown KA, et al. ACC/AHA guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy. Anesth Analg. 2007;104:15–26.

    Article  Google Scholar 

  60. Devereaux PJ, Beattie WS, Chou PT, et al. How strong is the evidence for the use of perioperative beta blockers in noncardiac surgery? Systematic review and meta-analysis of randomized controlled trials. BMJ. 2005;331:313–21.

    Article  PubMed  CAS  Google Scholar 

  61. Weisbauer F, Schlager O, Domanovits H, et al. Perioperative B-blockers for preventing surgery related mortality and morbidity: a systematic review and meta-analysis. Anesth Analg. 2007;104:27–41.

    Article  Google Scholar 

  62. Howell SJ, Sear JS, Foex P. Hypertension, hypertensive heart disease and perioperative risk. Br J Anaesth. 2004;92:570–83.

    Article  PubMed  CAS  Google Scholar 

  63. Abou-Chebl A, Yadav JS, Reginelli JP, et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid surgery. Risk factors, prevention and treatment. J Am Coll Cardiol. 2004;43:1596–601.

    Article  PubMed  Google Scholar 

  64. Durazzo AD, Marchado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004;39:967–76.

    Article  PubMed  Google Scholar 

  65. Lindenauer PK, Pekow P, wang K, et al. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA. 2004;291:2092–9.

    Article  PubMed  CAS  Google Scholar 

  66. Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003;107:1848–51.

    Article  PubMed  CAS  Google Scholar 

  67. Schouten O, Boersma E, Hoeks SE. The Dutch echocardiographic cardiac risk evaluation applying stress echocardiography study group. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med. 2009;361:980–9.

    Article  PubMed  CAS  Google Scholar 

  68. Heeschen C, Hamm CW, Laufs U, et al. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation. 2002;105:1446–52.

    Article  PubMed  CAS  Google Scholar 

  69. Welten GMJM, Chonchol M, Schouten O, et al. Statin use is associated with early recovery of kidney injury after vascular surgery and improved long-term outcome. Nephrol Dial Transplant. 2008;23:3867–73.

    Article  PubMed  CAS  Google Scholar 

  70. Poldermans D. Statins and non-cardiac surgery: current evidence and practical considerations. Cleve Clin J Med. 2009;76:S79–83.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology – Medicine, Hospital for Special Surgery, New York, NY, USA

    C. Ronald MacKenzie M.D.

  2. Department of Anesthesia, Hospital for Special Surgery, Weil Medical College of Cornell University, New York, NY, USA

    Michael K. Urban M.D., Ph.D.

Authors
  1. C. Ronald MacKenzie M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael K. Urban M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Ronald MacKenzie M.D. .

Editor information

Editors and Affiliations

  1. Department of Rheumatologic, and Immunologic Disease, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Brian F. Mandell

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

MacKenzie, C.R., Urban, M.K. (2013). Preoperative Cardiovascular Risk Assessment. In: Mandell, B. (eds) Perioperative Management of Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2203-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-2203-7_5

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2202-0

  • Online ISBN: 978-1-4614-2203-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation