1. Preoperative Assessment and Management of Cardiovascular Risk in Patients Undergoing Non-Cardiac Surgery: Implementing a Systematic Stepwise Approach during the COVID-19 Pandemic Era
- Author
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Vincenzo Maffei, Rosangela Cocchia, Rajendra H. Mehta, Paolo Fedelini, Alessandro Perrella, Massimo Majolo, Maurizio De Palma, Mara Catalano, Giuseppe Longo, Imran Hayat Tarrar, Gaetano Romano, Salvatore Chianese, Ciro Coppola, Brigida Ranieri, Olga Vriz, Filippo Cademartiri, Domenico Galzerano, Andrea Salzano, Ciro Mauro, Eduardo Bossone, Hani Alsergani, Giuseppe Lo Russo, Antonio Frangiosa, Rahul M. Mehta, Luigia Romano, Carlo Ruotolo, Valentina Capone, Chiara Sepe, Ciro Esposito, Eliana Raiola, Gianluca Guggino, Roberto Annunziata, Mario Muto, Bossone, E., Cademartiri, F., Alsergani, H., Chianese, S., Mehta, R., Capone, V., Ruotolo, C., Tarrar, I. H., Frangiosa, A., Vriz, O., Maffei, V., Annunziata, R., Galzerano, D., Ranieri, B., Sepe, C., Salzano, A., Cocchia, R., Majolo, M., Russo, G., Longo, G., Muto, M., Fedelini, P., Esposito, C., Perrella, A., Guggino, G., Raiola, E., Catalano, M., De Palma, M., Romano, L., Romano, G., Coppola, C., Mauro, C., and Mehta, R. H.
- Subjects
medicine.medical_specialty ,Revised Cardiac Risk Index ,medicine.medical_treatment ,non-cardiac surgery ,Review ,Disease ,Revascularization ,Non‐cardiac surgery ,COVID‐19 ,teleconsulting ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Pharmacology (medical) ,Myocardial infarction ,General Pharmacology, Toxicology and Pharmaceutics ,Adverse effect ,business.industry ,COVID-19 ,Percutaneous coronary intervention ,Perioperative ,medicine.disease ,perioperative cardiovascular management ,RC666-701 ,Emergency medicine ,business ,Risk assessment - Abstract
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.
- Published
- 2021