Risk Stratification for Noncardiac Surgery

Letters6 January 2004Risk Stratification for Noncardiac SurgerySteven L. Cohn, MDSteven L. Cohn, MDFrom SUNY Downstate Medical Center, Brooklyn, NY 11203.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-1-200401060-00037-w2 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I was disturbed by the algorithm proposed by Drs. Grayburn and Hillis (1), which essentially said that if cardiac catheterization were not indicated independent of the need for surgery, virtually all patients could undergo surgery without further testing (using β-blockers). I currently favor a combination of the American College of Cardiology- and Lee-revised cardiac index modified with the use of β-blockers (2), and I am a strong proponent of minimizing preoperative tests that are unlikely to change management. I agree with the proposed algorithm for patients with low and intermediate clinical risk; however, at this time, I ...Reference1. Grayburn PA, Hillis LD. Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy. Ann Intern Med. 2003;138:506-11. [PMID: 12639086] LinkGoogle Scholar2. Cohn SL, Goldman L. Preoperative risk evaluation and perioperative management of patients with coronary artery disease. Med Clin North Am. 2003;87:111-36. [PMID: 12575886] CrossrefMedlineGoogle Scholar3. Boersma E, Poldermans D, Bax JJ, Steyerberg EW, Thomson IR, Banga JD, et al . Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and β-blocker therapy. JAMA. 2001;285:1865-73. [PMID: 11308400] CrossrefMedlineGoogle Scholar4. Torres MR, Short L, Baglin T, Case C, Gibbs H, Marwick TH. Usefulness of clinical risk markers and ischemic threshold to stratify risk in patients undergoing major noncardiac surgery. Am J Cardiol. 2002;90:238-42. [PMID: 12127610] CrossrefMedlineGoogle Scholar5. Karkos CD, Thomson GJ, Hughes R, Hollis S, Hill JC, Mukhopadhyay US. Prediction of cardiac risk before abdominal aortic reconstruction: comparison of a revised Goldman Cardiac Risk Index and radioisotope ejection fraction. J Vasc Surg. 2002;35:943-9. [PMID: 12021711] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From SUNY Downstate Medical Center, Brooklyn, NY 11203. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCardiac Events in Patients Undergoing Noncardiac Surgery: Shifting the Paradigm from Noninvasive Risk Stratification to Therapy Paul A. Grayburn and L David Hillis Risk Stratification for Noncardiac Surgery Shaun D. Frost and Franklin A. Michota Metrics Cited byOptimal lipid modification: the rationale for combination therapy 6 January 2004Volume 140, Issue 1Page: W-2KeywordsAlgorithmsCardiac surgeryCatheterizationLeft ventricular ejection fractionMedical risk factorsRevascularizationSurgery ePublished: 6 January 2004 Issue Published: 6 January 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...