Preoperative Assessment of the Cardiac Patient Undergoing ...

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“Low Risk” Non Cardiac Surgery Known CAD CAD-Medical Medical Rx – Pre BetaBlocker Era Type of Surgery # Patients MI Death MI/Death Urologic 225 0.9% 0.9% 1.8% Orthopedic 159 0.6% 0.6% 1.2% “Low Risk” 484 0.8% 0.8% 1.6% Eagle K, et al. Circulation 1997;96:1882-87.
Cardiovascular Risk: Non Cardiac S Surgery Surgery NSQIP Data: D t 2002 2002-2005 2002 2002-2005 2002 2005 Procedure (n) ( ) Mortalityy Morbidityy Combined Endovascular AAA (600) 1.67% 12.83% 14.50% Carotid Endarterectomy (1717) 0.58% 8.44% 7.02% Parathyroid Surgery (1651) 0.42% 2.29% 2.71% Inguinal Hernia (4321) 0.14% 1.47% 1.61% Thyroidectomy (3041) 0.06% 1.51% 1.57% Breast (3855) 00.00% 00% 11.22% 22% 11.22% 22% Lumpectomy
Page 1 and 2: Preoperative Assessment of the Card
Page 3 and 4: Lecture Outline • Estimating Pati
Page 5 and 6: "Always Always make make things as
Page 7 and 8: Death . MI or Periop. 10% Clinical
Page 9 and 10: Mortality Data: Anaerobic Threshold
Page 11 and 12: Surgery g y - Specific Specific p R
Page 13: Adjusteed Mortallity (%) 12 8 4 0 O
Page 17 and 18: Predictors of Death at 30 Days: Bar
Page 19 and 20: Questions: Who Needs Further NonInv
Page 21 and 22: NonCardiac Testing Prior to Vascula
Page 23 and 24: Preoperative Dobutamine E Echocardi
Page 25 and 26: Clinical Assessment Only 1081 patie
Page 28 and 29: Fatal Perioperative MI Coronary C C
Page 30 and 31: Peri Peri-operative operative p Man
Page 32 and 33: Perrcentage of o Patientts 40 30 20
Page 34 and 35: B-Blockers Blockers to to Lower Low
Page 36 and 37: Effect of Perioperative BB-Blockade
Page 38 and 39: “Evidence does not support the us
Page 40 and 41: *Average heart rate 72 bpm - BB vs.
Page 42 and 43: POISE Trial: Metoprolol vs. Placebo
Page 44 and 45: Negative Consequences of Sudden Dis
Page 46 and 47: Recommendations for Beta Beta-Block
Page 48 and 49: How Do I Use Beta Blockers? • Met
Page 50 and 51: In-hospital Mortality after Non-Car
Page 52 and 53: Carddiac death or nonnfatal MII (%)
Page 54 and 55: Outcome: Primary End Point Log-rank
Page 56 and 57: Aspirin in CVD Antithrombotic Trial
Page 58 and 59: Influence of Prior CABG to Lower Ri
Page 60 and 61: What About Immediate Coronary Revas
Page 62 and 63: Death/MI after Non Cardiac Surgery
Page 64 and 65:
DES and Non-cardiac Surgery: Erasmu
Page 66 and 67:
CARP: Coronary Revascularization P
Page 68 and 69:
CARP: Main Results Revasc. No Revas
Page 70 and 71:
Long Term Survival in CARP (2 (2-5
Page 72 and 73:
But should we we revascularize reva
Page 74 and 75:
Cardiac Risk of Vascular Surgery DE
Page 76 and 77:
Timing of Surgery Perioperative Gui
Page 78 and 79:
Who Needs Coronary y Angiography? g
Page 80 and 81:
Potential Approach pp 1. Stable Cli
Page 82 and 83:
Perioperative p Pain Management g
Page 84 and 85:
Post Operative Therapy and F Future
Page 86 and 87:
Resource Use and Outcomes After Imp
Page 88 and 89:
“Prediction Is Very Difficult, Es
Page 90:
“M “Medicine di i is i an Art A
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