PREOPERATIVE EVALUATION IN NON-CARDIAC SURGERY: CARDIAC RISK ASSESSMENT

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Abstract
Nine hundred and ninety patients, ages 20 years or older, undergoing non-cardiac elective surgery were prospectively studied to identify high cardiac risk preoperative factors in a case-mix population and to assess cardiological risk. The prevalence of major cardiac complications was 2.3%, including 0.8% mortality. Un/variate analysis showed that: age; history of chest pain; dyspnea, hypertension; presence of systolic murmur and third sound; diastolic pressure >95 mmHg; electrocardiogram left ventricular hypertrophy; cardiothoracic ratio >0.5 and va/vu/ar calciflcalion.s are associated with cardiac complications (p =0.001-0.02), with low sensitivity (range: 14-38%) and high specificity (range: 85-98%). Cardiological referral was required for 169 patients (17%) that showed a higher prevalence of cardiovascular diseases (85%) and of cardiac complications (5.3%). Cardiologists req ui red further tests for 13 patients (7.7%) and modified therapy for 93 (55%). High cardiac risk patients are identified preoperatively in current practice and cardiological referral is frequent; fi.trther studies are mandatory to evaluate the most effective and efficacious procedures.

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