Cardiac events are the major cause of morbidity and mortality in patients undergoing non-cardiac surgery, and new guidelines issued Monday by the European Society of Cardiology (ESC) at its annual congress in Barcelona, Spain, address this common and complicated challenge.
The risk of cardiac complications depends on the condition of the patient prior to surgery, the prevalence of heart disease and the magnitude and duration of the surgical procedure. After major surgery, the incidence of cardiac death varies between 0.5 percent and 1.5 percent, and of non-fatal cardiac complications, between 2 and 3.5 percent. When applied to the population in the EU member states, these figures translate into 150,000 to 250,000 life-threatening cardiac complications resulting from non-cardiac surgical procedures, annually.
The guidelines recommended a practical evaluation of the patient, which integrates cardiac risk factors and test results with the estimated stress of the planned surgical procedure. The guidelines focus on non-cardiac surgery.
Cardiac complications are more likely to occur in patients with documented or asymptomatic ischemic heart disease, left ventricular dysfunction and valvular heart disease undergoing surgical procedures associated with prolonged hemodynamic and cardiac stress. Therefore, the guidelines recommended pre-operative assessment of clinical risk factors, such as heart failure, previous MI and diabetes mellitus, to stratify patients according to risk of cardiac events.
However, the use of additional cardiac testing, such as echocardiography or exercise testing, is only recommended for patients with multiple risk factors scheduled for high-risk surgery, in order to assess the presence and extent of ischemic heart disease.