Society GuidelinesCanadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
Section snippets
Guidelines Development
The primary panel established the scope of the guidelines (ie, 4 themes: preoperative cardiac risk assessment, perioperative cardiac risk modification, monitoring for perioperative cardiac events, and management of perioperative cardiac complications), identified topics and working groups, searched the literature, developed the summary of findings and GRADE quality assessment tables, voted on the recommendations, and wrote the guidelines. The secondary panel reviewed the guidelines manuscript
Preoperative Cardiac Risk Assessment
Accurate preoperative cardiac risk estimation can serve several functions. Valid estimates of the risks and benefits of surgery can facilitate informed decision-making about the appropriateness of surgery. Accurate cardiac risk estimation can also guide management decisions (eg, consideration of endovascular vs open surgical approach) and inform decisions around monitoring (eg, troponin measurements) after surgery.
Perioperative Cardiac Risk Modification
Table 4 shows the recommended management of interventions that target perioperative cardiac risk.
Troponin monitoring
Supplemental Tables S40 and S41 show the summary of findings and GRADE quality assessment for postoperative troponin monitoring, respectively. Most myocardial infarctions occur within 48 hours of noncardiac surgery when patients are receiving analgesic medications that can mask ischemic symptoms.27 This provides an explanation as to why 65% of patients who suffer a perioperative myocardial infarction do not experience ischemic symptoms, and without perioperative troponin monitoring these
ASA and statin in patients who suffer MINS
Supplemental Tables S50 and S51 show the summary of findings and GRADE quality assessment for ASA and statin in patients who suffer MINS. One prospective cohort study and one retrospective case-control study with propensity score-matching have investigated the question of initiation of ASA and statin therapy in patients who had suffered a myocardial injury or myocardial infarction after noncardiac surgery.27, 88 In the prospective cohort study, among the 415 patients who suffered a myocardial
Conclusions and Future Research
Throughout the past 2 decades, large clinical trials and prospective observational studies have advanced our understanding of predicting, modifying the risk of, monitoring for, and managing perioperative cardiac complications. Despite these advances, cardiac complications after noncardiac surgery remain a substantial public health problem. There is a need for more large international studies to evaluate promising lines of investigation. Examples include the use of remote, automated, continuous,
Funding Sources
Funding to support a face-to-face meeting of the primary panel was supported through a McMaster University Scholar Award received by Dr Devereaux.
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The disclosure information of the authors and reviewers is available from the CCS on their guidelines library at www.ccs.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.