Perioperative Cardiovascular Risk Stratification and Modification

Worldwide, annually approximately 100 million people undergo some form of non-cardiac surgery. Cardiac events, such as myocardial infarction are a major cause of perioperative morbidity and mortality in these patients. Though the true incidence of perioperative cardiac complications is difficult to assess, it is estimated that approximately 2.0–3.5% of patients undergoing major non-cardiac surgery experience a major adverse cardiac event. Furthermore an estimated 0.5–1.5% of patients die within 30 days after the surgical procedure due to a cardiovascular cause. The pathophysiology of perioperative cardiac events is complex. Similar to the non-operative setting it is thought that approximately half of all perioperative myocardial infarctions are attributable to a sustained coronary oxygen demand/supply mismatch. Coronary plaque rupture, leading to thrombus formation and subsequent vessel occlusion, is thought to be the other important cause of acute perioperative coronary syndromes.