Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery

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• 作者：Emmanuelle Duceppe ; MD^a ; ^b ; ^c ; Joel Parlow ; MD ; MSc^d ; ^{parlowj@queensu.ca} (Co-chair) ; Paul MacDonald ; MD^e ; Kristin Lyons ; MDCM^f ; Michael McMullen ; MD^d ; Sadeesh Srinathan ; MD ; MSc^g ; Michelle Graham ; MD^h ; Vikas Tandon ; MDⁱ ; Kim Styles ; MD^j ; Amal Bessissow ; MD ; MSc^k ; Daniel I. Sessler ; MD^l ; Gregory Bryson ; MD ; MSc^m ; ⁿ ; P.J. Devereaux ; MD ; PhD^b ; ^c ; ⁱ (Co-chair)
• 刊名：Canadian Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：33
• 期：1
• 页码：17-32
• 全文大小：558 K
• 卷排序：33

文摘

The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.