Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery Emmanuelle.

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Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery Emmanuelle Duceppe, MD, Joel Parlow, MD, MSc, Paul MacDonald, MD, Kristin Lyons, MDCM, Michael McMullen, MD, Sadeesh Srinathan, MD, MSc, Michelle Graham, MD, Vikas Tandon, MD, Kim Styles, MD, Amal Bessissow, MD, MSc, Daniel I. Sessler, MD, Gregory Bryson, MD, MSc, P.J. Devereaux, MD, PhD Canadian Journal of Cardiology Volume 33, Issue 1, Pages 17-32 (January 2017) DOI: 10.1016/j.cjca.2016.09.008 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Preoperative risk assessment and postoperative monitoring flow diagram. BNP, brain natriuretic peptide; ECG, electrocardiogram; NT-proBNP, N-terminal pro-brain natriuretic peptide; PACU, postanesthesia care unit; PHTN, pulmonary hypertension; RCRI, Revised Cardiac Risk Index. ∗ Significant cardiovascular disease includes known history of coronary artery disease, cerebral vascular disease, peripheral artery disease, congestive heart failure, severe PHTN or a severe obstructive intracardiac abnormality (eg, severe aortic stenosis, severe mitral stenosis, or severe hypertrophic obstructive cardiomyopathy). ‡ Timing of surgery refers to emergency surgery (eg, severe trauma, ruptured aortic aneurysm), urgent surgery (eg, hip fracture, bowel obstruction), semiurgent surgery (eg, cancer with potential to metastasize), or elective surgery (eg, knee arthroplasty). £ If physical examination suggests there is an unknown severe obstructive intracardiac abnormality (eg, severe aortic stenosis, severe mitral stenosis, or severe hypertrophic obstructive cardiomyopathy) or severe PHTN, then obtain an echocardiogram before surgery to inform the anesthesiologist, surgeon, and medical team of the type and degree of disease. If the history suggests the patient has an unstable cardiac condition (eg, unstable angina) then discussion with the patient and surgical/medical team is required to decide whether to delay, cancel, or proceed with surgery. § RCRI score (each worth 1 point): history of coronary artery disease, cerebrovascular disease, congestive heart failure, preoperative insulin use, preoperative creatinine > 177 μmol/L, and high-risk surgery (ie, intraperitoneal, intrathoracic, or suprainguinal vascular surgery). ∗∗ Shared-care management refers to a multidisciplinary approach to inpatient postoperative care; this includes the surgeon and a medical specialist (eg, internist, cardiologist, gerontologist), who will help with perioperative monitoring and management of cardiovascular complications. Canadian Journal of Cardiology 2017 33, 17-32DOI: (10.1016/j.cjca.2016.09.008) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions