Perioperative cardiovascular evaluation: heads or tails?

• Main Authors: Gabriel A.L. Carmo, Daniela Calderaro, Pai C. Yu, Danielle M. Gualandro, André C. Marques, Cristina S. Bittar, Adriana F. Pastana, Bruno Caramelli
• Format: Article
• Language: English
• Published: Associação Médica Brasileira 2012-08-01
• Series: Revista da Associação Médica Brasileira
• Subjects: Perioperative care; general surgery; brain natriuretic peptide; general anesthesia; cardiovascular risk; ankle-brachial index
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302012000400025

When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.