Perioperative Cardiac Risk Assessment - RM Solutions

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Risk Indices 1963 – ASA physical status classification used Many different risk scores 1977 - Goldman identified 9 cardiac risk factors • Simple models – multivariate analysis – Cardiac risk index (i.e. Goldman index) – Larsen risk index – Revised cardiac risk index (i.e. Lee index) – CCS index (i.e. Gilbert index) • Bayesian models – Detsky index – Veteran Affairs index 1986 – Detsky added angina class & prior MI 1997 – modified to stratify into 3 risk groups (ACP)
Detsky Modified Risk Index
Page 1 and 2: Perioperative Cardiac Risk Assessme
Page 3 and 4: Medical Consultation • The preope
Page 5 and 6: Outline I 1. Coronary Risk • Clin
Page 8 and 9: JACC Vol. 50, No. 17, 2007 ACC/AHA
Page 10 and 11: JACC Vol. 50, No. 17, 2007 ACC/AHA
Page 14 and 15: Revised Cardiac Risk Index (LEE)
Page 16 and 17: Validation of Risk Indices • Many
Page 18 and 19: Part I: Coronary Risk Stratificatio
Page 20 and 21: Preop Assessment Need for noncardia
Page 22 and 23: Intermediate Clinical Predictors In
Page 24 and 25: Functional Capacity 1 MET 4 METs
Page 26 and 27: Stepwise Approach Summary No furthe
Page 28 and 29: • After estimating a patient’s
Page 30 and 31: Strengths and Weaknesses of Preoper
Page 32 and 33: Predicators of Cardiac Events After
Page 34 and 35: Results Clinical risk score B-Block
Page 36 and 37: Conclusions Dobutamine stress echo
Page 38 and 39: Intervention • Preoperative cardi
Page 40 and 41: Poldermans, et al • Regardless of
Page 42 and 43: Resting LV Function • In general,
Page 44 and 45: Stress Testing Class I Class IIa Cl
Page 46 and 47: Still a paucity of strong evidence
Page 48 and 49: Coronary-Artery Revascularization B
Page 50 and 51: Conclusions • Coronary artery rev
Page 52 and 53: Coronary artery stenting and noncar
Page 54 and 55: Conclusion • Adverse cardiovascul
Page 56 and 57: Preoperative PCI • No randomized
Page 58 and 59: Significantly more non-fatal MI’s
Page 60 and 61: Conclusion • For patients with st
Page 62 and 63:
Preoperative Medical Rx
Page 64:
Use of perioperative B- blockade!!!
Page 67 and 68:
Perioperative Beta-Blockers Meta-An
Page 69 and 70:
Perioperative Medical Rx Recommenda
Page 71 and 72:
What Does the Future Hold POISE
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Perioperative Cardiac Risk Assessment - RM Solutions

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