Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk
Population
Patients undergoing noncardiac surgery
Design
Review
Authors
Discussion
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Implication
Lee index may inform perioperative risk assessment in noncardiac surgery; leaves open the accuracy of noninvasive tests and ACC/AHA algorithm.
Key Points
- To review the global incidence, underlying pathophysiology, and predictive accuracy of risk assessment tools for perioperative cardiac events in patients undergoing noncardiac surgery.
- Narrative review evaluating clinical evidence on perioperative cardiac death, nonfatal myocardial infarction, and nonfatal cardiac arrest.
- Assessed predictive accuracy and clinical utility of generic risk indices (such as the Lee index), ACC/AHA algorithms, and noninvasive cardiac tests.
- Annually, between 500,000 and 900,000 patients worldwide experience perioperative cardiac death, nonfatal myocardial infarction, or nonfatal cardiac arrest during noncardiac surgery.
- The Lee index represents the most accurate generic perioperative risk tool, whereas substantial uncertainty persists regarding the predictive utility of noninvasive cardiac testing and the ACC/AHA algorithm.
- Evidence indicates that a substantial proportion of fatal perioperative myocardial infarctions possess distinct pathophysiological mechanisms compared to nonoperative events.
Structured PICO
P
Population
Patients undergoing noncardiac surgery
O
Outcome
Perioperative cardiac events (cardiac death, nonfatal myocardial infarction, or nonfatal cardiac arrest)
Accurate perioperative cardiac risk estimation, potentially best achieved with the Lee index, is crucial for informed decision-making in patients undergoing noncardiac surgery.
Limitations
- Limited evidence on the pathophysiology of fatal perioperative MIs
- Uncertainty regarding the predictive accuracy of noninvasive cardiac tests and the ACC/AHA algorithm
Cite This Study
Devereaux et al. (2005) studied this question.