Surgical: preoperative assessment
Preoperative cardiac assessment — ESC pathway
Steps through the 2022 ESC non-cardiac surgery pathway: urgency, surgical risk, patient risk (age, CVD, risk factors, symptoms), active cardiac conditions, RCRI, functional capacity and natriuretic peptides. Returns the tests indicated, the timing of elective surgery after PCI or MI, and perioperative management of beta-blockers, statins, RAAS inhibitors, SGLT2 inhibitors and antiplatelet agents.
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Surgery
Patient
Active cardiac conditions
Defer elective surgery and treat first
Revised Cardiac Risk Index
RCRI 0/6
Functional capacity and biomarkers
BNP / NT-proBNP
Recent coronary events
Timing of elective surgery
Preoperative cardiac assessment · ESC 2022
Choose urgency, surgical risk and age.
References
- Halvorsen S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022;43:3826-3924.
- Thompson A, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for perioperative cardiovascular management for noncardiac surgery. Circulation 2024;150:e351-e442.
- Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043-1049.
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