Cardiac Complications after Non-cardiac Surgery: Perioperative Risk Prediction and Reduction Strategies
2013
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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.
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