Preoperative Assessment of the Cardiac Patient Undergoing ...

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*Average heart rate 72 bpm - BB vs. 78 bpm - Placebo Diabetic Postoperative Morbidity M MMorbidity bidit and d Mortality M t lit Trial T i l 921 Patients Diabetic/No known CAD B Blocker* Randomization Placebo* Atenolol 50mg evening prior to surgery Atenolol 100mg Q A.M. Non Cardiac Surgery Non Cardiac Surgery ( (>50% 50% Abd. Abd or Orthopedic) O th di ) ( (>50% 50% Abd. Abd or Orthopedic) O th di ) Combined In hospital endpoint, Mortality, MI, , Unstable angina, g , Heart failure 21% (All cause death - 16% for both groups) 20%
Peri erioperative perative Ischemic Is chemic Evaluation valuation 30 Day Event Non Fatal MI CV Death, MI, ♥ Arrest Stroke Bradycardia Toprol XL 100mg 22-4 H Hrs P PPreop Preop→ 30 Days POISE POISE Trial T i l 8351 Patients + RRandomized d i d Placebo acebo + >45yrs of age Had or at risk for Atherosclerosis Atherosclerosis-82% 82% Had CAD or PVD Toprol Placebo P-value 3.6% 5.1%
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 and 14: Adjusteed Mortallity (%) 12 8 4 0 O
Page 15 and 16: Cardiovascular Risk: Non Cardiac S
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 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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