Risk Evaluation of Perioperative Acute Coronary Syndromes and Other Cardiovascular Complications During Emergency High Risky Noncardiac Surgery

Abstract

The cardiac risk (CR) in noncardiac surgery represents the probability of acute cardiovascular conditions appearance, assessed as perioperative complications. The most frequent perioperative complications are the acute manifestations of coronary or noncoronary ischemia; acute or exacerbated chronic heart failure (CHF); acute rhythm and conductive disorders; acute cardiac inflammatory processes; increased arterial blood pressure or hypertensive crisis; cardiogenic shock and sudden cardiac death. These conditions are either early signs, or represent a manifestation of progress or decompensation of present cardiac diseases. Specific indication may be found in their origin, if it is explicitly or implicitly associated with the present surgical disease or with a completed surgical intervention, giving weight to the special features of the perioperative period [1]. The major surgical interventions, e.g. in the thoracic cavity and the upper abdominal cavity, as well as the neurosurgical and the major orthopedic operations, are related to increased CR. Previous myocardial infarction, unstable stenocardia and decompressed chronic cardiac insufficiency are powerful predictors for the emergence of acute perioperative cardiovascular complications (CVC) and mortality. The patients with such specified pathologies need additional evaluation before major surgical intervention. The cardiac postoperative morbidity and mortality are closely related to the basic surgical disease and the corresponding intervention. Many scientific publications report on the high number of complications, accompanying the major surgical abdominal and intrathoracic interventions, emergency surgical interventions, surgery of malignant neoplasm, major peripheral vascular manipulations [1, 2, 3]. The CR evaluation will not change the course and the result of the intervention in emergency conditions, e.g. rupture of abdominal aortic aneurism, heavy trauma, perforations etc., but may have influence upon the care during the early postoperative period. In emergency but noncritical states (e.g. biliary obstruction), the evaluation may contribute to risk reduction without influence upon the decision about the necessity of the intervention. In some cases, the CR evaluation may influence the surgical intervention planning and the choice of less invasive