Cardiac Complications after Non-cardiac Surgery: Perioperative Risk Prediction and Reduction Strategies

Abstract

Introduction | 9 I More than 200 million people worldwide undergo non-cardiac surgery annually. It is estimated that 2-5 percent of these patients suffer a cardiac complication (i.e. myocardial infarction, congestive heart failure, arrhythmia), resulting in death in approximately 0.5 percent of all patients. The frequent occurrence of devastating cardiac complications necessitates a thorough assessment of the risk of cardiac complications in every patient scheduled for non-cardiac surgery. This risk is influenced by the preoperative condition of the patient and the invasiveness of the planned procedure, and is modifiable by various interventions. Chapter 1 provides an overview of cardiac risk assessment and risk reduction strategies. Surgery induces several changes that predispose to cardiac complications: the induced catecholamine surge, tachycardia, and increased myocardial contractility may, in the presence of a flow-limiting coronary stenosis, lead to a myocardial oxygen supply-to-demand mismatch and subsequent myocardial infarction. The systemic inflammatory response and pro-thrombotic state provoked by surgery increase the risk of rupture of unstable coronary plaque and subsequent thrombotic coronary artery occlusion and myocardial infarction.