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REVIEW ARTICLE
Year : 2014  |  Volume : 13  |  Issue : 1  |  Page : 6-15

Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries


Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin, Kerala, India

Correspondence Address:
Dr. Subramanyam Padma
Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Ponekkara Post, Cochin - 682 041, Kerala
India
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DOI: 10.4103/1450-1147.138568

PMID: 25191106

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The increasing number of patients with coronary artery disease (CAD) undergoing major noncardiac surgery justifies guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major noncardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient's probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing noncardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing noncardiac surgery and highlight the importance of myocardial perfusion imaging in risk stratifying these patients.


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