Perioperative cardiac risk assessment

Perioperative cardiac risk assessment estimates cardiovascular complications surrounding noncardiac surgery and guides decisions about testing, treatment, timing, and monitoring.

Connect

Revised Cardiac Risk Index: A clinical score estimating major cardiac complications after noncardiac surgery from six patient and procedure factors. It translates several established risk factors into a practical estimate of perioperative cardiac events.
Atherosclerotic cardiovascular disease: Disease caused by plaque buildup in arteries, including coronary, cerebrovascular, and peripheral arterial disease. Existing vascular disease is a major marker of elevated perioperative cardiac risk.
Preoperative evaluation: The assessment of a patient's health and readiness before a planned operation. Cardiac evaluation is integrated with broader review of medical conditions and surgical plans.
Cardiac stress testing: Tests that assess cardiac function or blood flow during exercise or pharmacologically induced stress. Preoperative testing is a selective tool, not a default step for every surgical patient.
Cardiac biomarkers: Measurable substances in blood that indicate cardiac injury, stress, or dysfunction. Troponin and natriuretic peptides may refine estimates, but their optimal use varies by patient and setting.
American College of Surgeons NSQIP Surgical Risk Calculator: An online tool that estimates procedure-specific postoperative complications using patient characteristics and planned surgery. It offers individualized estimates that complement cardiac-specific scores.
Heart failure: A clinical syndrome in which structural or functional heart disease impairs filling or ejection of blood. Active or recent heart failure strongly affects decisions about surgical timing and monitoring.
Preoperative stress testing: Testing that provokes or images cardiac stress before surgery to detect clinically significant ischemia. It is considered when results could alter treatment or the decision to proceed.
Coronary artery calcium score: A computed-tomography measure of calcified plaque burden in the coronary arteries. It estimates long-term atherosclerotic risk but is not a routine test of perioperative ischemia.
High-sensitivity cardiac troponin: A blood test that detects very low concentrations of proteins released by injured heart muscle. Its ability to identify postoperative injury raises questions about whom to screen and how to respond.