Skip to main content
SpringerLink
Log in

Kommentar zu den „ESC Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery“

Commentary on the ESC Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery

  • Leitlinien
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die aktuelle Leitlinie der ESC stellt ein hilfreiches und im klinischen Alltag praktikables Instrument in der Risikostratifizierung von Patienten im Kontext eines geplanten operativen Eingriffes als auch im perioperativen Management dar. Besonders wertvoll erscheinen die klare Strukturierung der Risikostratifizierung von Patienten und geplantem operativem Eingriff in den 3 Risikokategorien niedrig, mittel und hoch und die sich daraus ableitenden Konsequenzen im medikamentösen als auch diagnostischen und interventionellen prä-, peri- und postoperativen Management. Der grundlegende Algorithmus und Entscheidungsbaum wird auch in den parallel zu diesem Kommentar publizierten Pocket-Leitlinien der Deutschen Gesellschaft für Kardiologie eine zentrale Stellung einnehmen.

Abstract

The current ESC guideline is a useful tool in clinical practice for cardiac risk stratification of patients in the context of surgical procedures as well as for perioperative management. The straight algorithm stratifies patients and surgical procedures into three categories: low, intermediate, and high risk. This results in an individualized medical therapy as well as diagnostic and interventional pre-, peri- and postoperative management. In parallel, the underlying algorithm will be published in the Pocket-Leitlinien of the German Society of Cardiology.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. http://www.prismant.nl/. Ziekenhuisstatistiek – Verrichtingen. 2008, Prismant

  2. Lee TH, Marcantonio ER, Mangione CM et al (1999) Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 100:1043–1049

    CAS  PubMed  Google Scholar 

  3. Boersma E, Kertai MD, Schouten O et al (2005) Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 118:1134–1141

    Article  PubMed  Google Scholar 

  4. Poldermans D, Bax JJ, Kertai MD et al (2003) Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation 107:1848–1851

    Article  CAS  PubMed  Google Scholar 

  5. 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 beta-blocker therapy with tight heart rate control? J Am Coll Cardiol 48:964–969

    Article  CAS  PubMed  Google Scholar 

  6. Poldermans D, Boersma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 341:1789–1794

    Article  CAS  PubMed  Google Scholar 

  7. Devereaux PJ, Yang H, Yusuf S et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371:1839–1847

    Article  CAS  PubMed  Google Scholar 

  8. Naughton C, Feneck RO (2007) The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. Int J Clin Pract 61:768–776

    Article  CAS  PubMed  Google Scholar 

  9. Monaco M, Stassano P, Di Tommaso L et al (2009) Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. J Am Coll Cardiol 54(11):989–996

    Article  PubMed  Google Scholar 

  10. Brady AR, Gibbs JS, Greenhalgh RM et al (2005) Perioperative betablockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial. J Vasc Surg 41:602–609

    Article  CAS  PubMed  Google Scholar 

  11. Juul AB, Wetterslev J, Gluud C et al (2006) Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 332:1482

    Article  PubMed  Google Scholar 

  12. Mangano DT, Layug EL, Wallace A, Tateo I (1996) Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 335:1713–1720

    Article  CAS  PubMed  Google Scholar 

  13. Yang H, Raymer K, Butler R et al (2006) The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 152:983–990

    Article  CAS  PubMed  Google Scholar 

  14. Zaugg M, Bestmann L, Wacker J et al (2007) Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: the Swiss Beta Blocker in Spinal Anesthesia (BBSA) study: a double-blinded, placebo-controlled, multicenter trial with 1-year follow-up. Anesthesiology 107:33–44

    Article  CAS  PubMed  Google Scholar 

  15. Beattie WS, Wijeysundera DN, Karkouti K et al (2008) Does tight heart rate control improve beta-blocker efficacy? An updated analysis of the noncardiac surgical randomized trials. Anesth Analg 106:1039–1048

    Article  CAS  PubMed  Google Scholar 

  16. Hindler K, Shaw AD, Samuels J et al (2006) Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 105:1260–1272; quiz 1289–1290

    Article  CAS  PubMed  Google Scholar 

  17. Williams TM, Harken AH (2008) Statins for surgical patients. Ann Surg 247:30–37

    Article  PubMed  Google Scholar 

  18. Schouten O, Hoeks SE, Welten GM et al (2007) Effect of statin withdrawal on frequency of cardiac events after vascular surgery. Am J Cardiol 100:316–320

    Article  CAS  PubMed  Google Scholar 

  19. Sun YP, Zhu BQ, Browne AE et al (2001) Comparative effects of ACE inhibitors and an angiotensin receptor blocker on atherosclerosis and vascular function. J Cardiovasc Pharmacol Ther 6:175–181

    Article  CAS  PubMed  Google Scholar 

  20. Burger W, Chemnitius JM, Kneissl GD, Rucker G (2005) Low-dose aspirin for secondary cardiovascular prevention-cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation-review and meta-analysis. J Intern Med 257:399–414

    Article  CAS  PubMed  Google Scholar 

  21. Biondi-Zoccai GG, Lotrionte M, Agostoni P et al (2006) A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J 27:2667–2674

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Kelm & T. Lauer

  2. Klinik für Innere Medizin, Kreiskrankenhaus Lörrach, Lörrach, Deutschland

    H. Osterhues

  3. Neurologische Universitätsklinik, Universitätsmedizin Mannheim UMH, Mannheim, Deutschland

    M. Hennerici

  4. Klinik für Kardiologie, Angiologie u. Pneumologie, Klinikum Esslingen, Esslingen, Deutschland

    M. Leschke

  5. Kardiologische Praxis, St. Elisabeth Krankenhaus Köln-Hohenlind, Köln, Deutschland

    A. Osterspey

Authors
  1. M. Kelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Osterhues
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Hennerici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Leschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Osterspey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Lauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Kelm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kelm, M., Osterhues, H., Hennerici, M. et al. Kommentar zu den „ESC Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery“. Kardiologe 4, 375–382 (2010). https://doi.org/10.1007/s12181-010-0293-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-010-0293-z

Schlüsselwörter

Keywords

Search

Navigation