Assessing and Reducing the Cardiac Risk of Noncardiac Surgery

ccurate estimation of a patient's risk for postoperative cardiac events (eg, myocardial infarction, unstable an- gina, ventricular tachycardia, pulmonary edema, and death) after noncardiac surgery can guide allocation of clinical resources, use of preventive therapies, and priorities for future research. This review addresses selected issues in clinical risk assessment, approaches to using diagnostic tests, choices among preventive interventions, and postoperative monitoring. Although we have not used a formal systematic review protocol, we emphasize evidence published after the American College of Cardiology/American Heart Associa- tion (ACC/AHA)1 and American College of Physicians (ACP)2 guidelines, outline the limitations of the evidence, and suggest clinical approaches. A summary of our review of the evidence is presented in Table 1, and suggested ap- proaches using these data are presented in Table 2 and Figures 1 and 2.