Chapter 5. Major Vascular Complications in Patients Undergoing Non-Cardiac Surgery: Magnitude of the Problem, Risk Prediction, Surveillance, and Prevention

  1. Salim Yusuf DPhil, FRCPC, FRSC Research Chair Professor of Medicine Director Vice President Research4,5,6,
  2. John A Cairns MD, FRCPC Professor of Medicine Former Dean7,
  3. A John Camm MD British Heart Foundation Professor Head of Cardiac8,
  4. Ernest L Fallen MD, FRCPC Professor Emeritus9 and
  5. Bernard J Gersh MB, ChB, DPhil Consultant Professor of Medicine10
  1. Philip J Devereaux MD, PhD, FRCP(C)1,
  2. Matthew Chan FANZCA2 and
  3. John Eikelboom MBBS, MSc, FRACP, FRCPA, FRCPC Associate Professor3

Published Online: 21 MAY 2010

DOI: 10.1002/9781444309768.ch5

Evidence-Based Cardiology, Third Edition

Evidence-Based Cardiology, Third Edition

How to Cite

Devereaux, P. J., Chan, M. and Eikelboom, J. (2009) Major Vascular Complications in Patients Undergoing Non-Cardiac Surgery: Magnitude of the Problem, Risk Prediction, Surveillance, and Prevention, in Evidence-Based Cardiology, Third Edition (eds S. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen and B. J. Gersh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444309768.ch5

Editor Information

  1. 4

    McMaster University, Canada

  2. 5

    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Canada

  3. 6

    Hamilton Health Sciences, Hamilton, Ontario, Canada

  4. 7

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

  5. 8

    St George's University of London, London, UK

  6. 9

    McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

  7. 10

    Mayo Clinic College of Medicine, Rochester, MN, USA

Author Information

  1. 1

    Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada

  2. 2

    Department of Anesthesia, The Chinese University of Hong Kong, Hong Kong, China

  3. 3

    Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Publication History

  1. Published Online: 21 MAY 2010
  2. Published Print: 13 NOV 2009

ISBN Information

Print ISBN: 9781405159258

Online ISBN: 9781444309768

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Keywords:

  • noncardiac surgery;
  • major perioperative vascular complications;
  • risk prediction;
  • surveillance;
  • prevention

Summary

Worldwide 200 million adults undergo major noncardiac surgery annually, and several million of these patients will suffer a major vascular complication (i.e., vascular death, nonfatal myocardial infarction, nonfatal cardiac arrest, nonfatal stroke) in the first 30 days after surgery. Studies have identified several clinical risk factors (e.g., coronary artery disease, cerebrovascular disease) to help identify patients at risk of a major perioperative vascular complication. A preoperative NT-proBNP measurement may substantially enhance perioperative vascular risk prediction. Troponin measurements for the first few days after surgery hold great promise as a surveillance strategy to allow physicians to avoid missing the majority of perioperative myocardial infarctions. The results of the POISE Trial, which demonstrated that a perioperative beta-blocker prevented myocardial infarctions but at a cost of excess strokes and deaths, highlight why large perioperative trials are necessary. There is encouraging evidence that several interventions (e.g., clonidine) may prevent major perioperative vascular complications; however, there is an urgent need for large trials to evaluate these interventions.