Perioperative Cardiac Risk Assessment

Assessment:
- History, physical
- Resting 12 lead ECG
- should be enough to stratify patients into low, intermediate and high cardiac risk

Risk of cardiac death and nonfatal MI also depends on procedure:
High risk >5%:
- Emergency operations (particularly in elderly)
- aortic, major vascular, peripheral vascular surgery
- Extensive operations with large volume shifts or blood loss

Intermediate risk <5%
- intraperitoneal or intrathoracic
- CEA
- H&N surgery
- Orthopedic
- Prostate

Low (<1%:
- endoscopic procedures
- superficial biopsy
- Cataract
- Breast surgery

Some merit has been shown in perioperative B-blockade to reduce perioperative cardiac risk.
The POISE study was reviewed in EBRS
- at adose of Metoprolol 100mg BID there is cardioprotective effect at this dose (lower doses do not afford same protective effects)
- however, patients need to be aware of the increased risk of hypotension, stroke and death

MAnagement of perioperative MI:
- STEMI: should be revascularized ASAP (within 12 hours). In post-op pt this likely means angiography as early post-op pts may not be eligible for throbolytics
- NSTEMI: stabilize medically and undergo risk stratification when stable
- Therapy with ASA, B-blocker and often ACEi (particularly in pts with low EF or anterior MI)
- Most post-MI pts should also be placed on a statin at discharge.