Perioperative Cardiac Risk Assessment - RM Solutions

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Preop <strong>Assessment</strong> Need for noncardiac surgery Emergency Operating room Postop risk stratification and management Urgent or Elective No Coronary revasc within 5 yrs Yes Recurrent symptoms or signs No Yes Recent coronary evaluation Yes Recent coronary angiogram or XST Favourable Operating room No Clinical predictors Unfavourable or change in Sx’s Major clinical predictors Intermediate clinical predictors Minor or No clinical predictors
Major Clinical Predictors Major clinical predictors 1. Unstable coronary syndrome 2. Decompensated CHF 3. Significant arrhythmia 4. Severe valvular disease Consider delay or cancel surgery Consider coronary angiography Medical management and RF modification Care dictated by findings & Rx results
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 12 and 13: Risk Indices 1963 - ASA physical st
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 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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