[Evaluating cardiac risk in noncardiac surgery].

In the United States, more than 33 million patients undergo noncardiac surgery each year, at a cost of 450 000 million dollars per year. Approximately 4% of these patients present perioperative complications, at an additional cost of 25 000 million dollars per year.1 The number of cardiovascular complications arising from non-cardiac surgery exceeds 1 million patients worldwide.2 Due to the increasing size of the elderly population (defined as people over 65 years old) in most of the developed world, it is predicted that during the coming decades the number of surgical operations will increase by 25%, surgery-related costs by 50%, and perioperative complications by 100%.3 Given that more than 60% of patients with vascular disease also have coronary heart disease, the preoperative assessment of patients undergoing noncardiac surgery is a public health priority.4 Randomized clinical trials have been employed to design evidence-based strategies which can help to identify the people at greater risk of perioperative cardiac complications and to reduce risk. These recommendations have been summarized and published in the AHA/ACC guideline update.5 The AHA/ACC guidelines address 3 main issues. First, to identify cardiac risk in patients based on a background of cardiovascular disease and easily obtainable laboratory tests; second, to evaluate the patient’s functional capacity; and third, to define the Evaluating Cardiac Risk in Noncardiac Surgery