Risk stratification

William Vernick, Lee A. Fleisher

Research output: Contribution to journalReview articlepeer-review

Abstract

Perioperative cardiac complications pose the greatest risk to the estimated 100 million people undergoing non-cardiac surgery each year. Most of these complications are related to underlying pre-existing coronary artery disease (CAD). For over 40 years researchers have been studying perioperative cardiac risk and how best to estimate it. The goal of improved risk stratification is important for allowing accurate informed decision-making, both by the patient and their physicians. Risk stratification has taken on an important role in clinical decision-making, helping physicians decide in which patients additional medical therapies, such as coronary revascularization or perioperative beta-blockers, are necessary. Meta-analysis has found a significant improvement in the positive predictive value (PPV) for perioperative cardiac outcome with stress testing over that with clinical risk score alone. However, evidence is mounting that with the use of perioperative beta-blockers, the majority of intermediate and high-risk patients can safely undergo even major vascular surgery without further cardiac testing.

Original languageEnglish (US)
Pages (from-to)1-21
Number of pages21
JournalBest Practice and Research: Clinical Anaesthesiology
Volume22
Issue number1
DOIs
StatePublished - Mar 1 2008

Keywords

  • CABG
  • CAD
  • MI
  • PVD
  • anesthesia
  • beta-blockers
  • cardiac catheterization
  • cardiac risk stratification
  • cardiac stent
  • cardiac stress testing
  • ischemic heart disease
  • perioperative beta-blockers
  • prophylactic coronary revascularization
  • stress test
  • vascular surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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