Cardiac Complications of Non-Cardiac Surgery: Initial Approaches in the General Low-Risk Population in Spain

Abstract

Postoperative cardiovascular mortality and morbidity associated with noncardiac surgery is a field in which a great deal of research effort has been invested for many years, due to the fact that it has important implications, both from a clinical and an economic perspective.1 It is worth noting that cardiovascular events are relatively frequent in noncardiac surgery and their incidence is estimated, depending on the study, at 1% to 5%.2-5 The impact of these figures can be estimated if we take as an example a country such as the United States, where each year around 30 million surgical interventions are performed and around a third of those patients present coronary artery disease or risk factors for coronary artery disease.6 Out of all of these procedures, it is calculated that around 1 million may present cardiovascular complications, including perioperative myocardial infarction or cardiovascular death. Some of these patients present especially high risk. This is true for patients who undergo vascular surgery, in which the incidence of cardiovascular events can reach 34% and in which perioperative infarctions can cause rates of mortality ranging from 25% to 40%, at an estimated cost of around 20 000 million dollars.7 These considerations, among others, have led various scientific societies to prepare guidelines on appropriate treatment in these patients.8-10 The complexity of the problem, with the associated costs, has led to various studies being performed in an effort to identify factors that will allow a risk stratification to be developed. The results of these studies have been incorporated in the various clinical practice guidelines, which recommend that the initial approach to stratification of the risk is based on the clinical characteristics of the patients and the procedures.8-10 Of Cardiac Complications of Non-Cardiac Surgery: Initial Approaches in the General Low-Risk Population in Spain