Evaluating cardiac risk in noncardiac surgery patients
David L. Bronson, MDAddress reprint requests to D.L.B., Department of General Internal Medicine, A91, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Alan K. Halperin, MD
Thomas H. Marwick, MD, PhD
The cornerstones of the evaluation of cardiac risk in patients undergoing noncardiac surgery remain a thorough history and physical examination, and a resting electrocardiogram. However, new techniques to assess cardiac function allow more complete evaluation of high-risk patients.KEY POINTS
Patients at high risk include those with myocardial infarctions within the preceding 6 months, unstable angina, congestive heart failure, critical aortic stenosis, severe hypertension (diastolic blood pressure > 110 mm Hg), or peripheral vascular disease.
Patients undergoing vascular surgery have a higher risk of cardiac events and require a special approach to risk assessment and intervention.
Despite its imperfections, the Goldman index remains a useful tool to assess cardiac risk, because of its ease of use and relative weighting of risk factors.
High-risk patients should undergo further risk stratification using noninvasive testing before surgery. Medical management of all treatable conditions should be maximized.
All other patients, even those with known cardiovascular disease, can undergo surgery safely without further testing.