Identifying High Risk Patient for

Elective Non-Cardiac Surgery

Putrika PR Gharini, MD, FIHA, FAsCC

Further Reading Materials
Objectives

• To describe how to assess perioperative cardiac risk using

clinical risk factors and type of surgical procedure
• To describe a stepwise approach for pre-operative cardiac risk
assessment
• To know various risk indices for perioperative cardiac risk
• To be easy to use for practitioners
Non-Cardiac Surgery – The role of multidisciplinary
team
 Stepwise approach
(Canadian Cardiovascular Society Guidelines)

Canadian Journal of Cardiology 33 (2017) 17e32

(Circulation. 2014;130:e278-e333.)
 Stepwise Approach (ESC)

European Heart Journal (2014) 35, 2383–2431

Surgery
Surgery
• Goldman Cardiac Risk
Index
• Lee / Revised Cardiac
Risk Index
• NISQP
• Goldman Cardiac
Risk Index
• Lee / Revised
Cardiac Risk
Index
• NISQP
• Goldman
Cardiac Risk
Index
• Lee / Revised
Cardiac Risk
Index
• NISQP
 Recommendation on Cardiac Risk
Stratification
• Clinical risk indices are recommended to be used for peri-operative risk
stratification. I B
• The NSQIP model or the Lee risk index are recommended for cardiac peri-
operative risk stratification. I B
• Assessment of cardiac troponins in high-risk patients, both before and 48–72
hours after major surgery, may be considered. IIb B
• NT-proBNP and BNP measurements may be considered for obtaining
independent prognostic information for perioperative and late cardiac events
in high-risk patients. IIb B
• Universal pre-operative routine biomarker sampling for risk stratification and
to prevent cardiac events is not recommended. III C
 Conclusion
• Assessment of perioperative cardiac risk
using clinical risk factors and type of surgical
procedure
• A stepwise approach for pre-operative
cardiac risk assessment
• Various risk indices for perioperative cardiac
risk
-Matur Nuwun-