Consulenza cardiologica preoperatoria e rischio cardiovascolare peri-operatorio in pazienti ultrasessantacinquenni candidati a chirurgia non cardiaca: dalla teoria alla pratica Preoperative evaluation before non cardiac surgery in subjects older than 65 years

Preoperative evaluation before non cardiac surgery in subjects older than 65 years. G.F. Mureddu, P. Faggiano, F. Fattirolli. Non cardiac surgery is becoming increasingly common in elderly patients; they are usually affected by overt car- diac disease or show multiple risk factors, responsible for a higher incidence of perioperative fatal or nonfatal cardiac events. Of interest, acute myocardial infarction occurring in the perioperative period shows a high mortality rate in people over 65 years old. The cardiovascular risk stratification and periopera- tive management of subjects undergoing noncardiac surgery have been recently updated in the 2014 European Society of Cardiology Guidelines. However, several critical points still lack of strong evidence and are based on expert opinions only. For example, the use of drugs, such as beta- blockers, before, during and after the surgery, presents many uncertainties regarding the selection of patients more likely to benefit, dosage and duration of therapy, and ef- fects on outcome. Data on elderly patients undergoing non cardiac surgery are scarce. Accordingly, a prospective registry en- rolling a large number of aged subjects undergoing non car- diac surgery (particularly at high or intermediate risk) should be able to give us adequate insights on the manage- ment strategies currently used, on the incidence of death or cardiovascular events in the postoperative period and on the areas of potential improvement in care. Furthermore, the effects on outcome of structured programs of Guidelines im- plementation in the clinical practice of cardiologists, anes- thesiologists and other health personnel involved in periop- erative care, could be positive and should be evaluated.