Perioperative medical management of ischemic heart disease in patients undergoing noncardiac surgery

Current Opinion in Anaesthesiology

Volumn 20, Issue 3, 2007, Pages 254-260

  Feringa, Harm H H ^a   Bax, Jeroen J ^a   Poldermans, Don ^b  

^a LEIDEN UNIVERSITY MEDICAL CENTER   (Netherlands)

^b ERASMUS MEDICAL CENTER   (Netherlands)

Author keywords

Ischemic heart disease; Medical therapy; Noncardiac surgery; Risk stratification

Indexed keywords

ALPHA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; ANESTHETIC AGENT; ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BISOPROLOL; CALCIUM CHANNEL BLOCKING AGENT; CLONIDINE; DEXMEDETOMIDINE; DILTIAZEM; GLYCERYL TRINITRATE; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; METOPROLOL; MIVAZEROL; NATRIURETIC FACTOR; PLACEBO; VERAPAMIL;

CARDIOVASCULAR RISK; CAUSE OF DEATH; CLINICAL PRACTICE; CLINICAL TRIAL; CORONARY ARTERY DISEASE; EXERCISE TEST; HEART PROTECTION; HEART RATE; HEART STRESS; HIGH RISK PATIENT; HUMAN; ISCHEMIC HEART DISEASE; MAJOR SURGERY; PATIENT IDENTIFICATION; PERIOPERATIVE PERIOD; POSTOPERATIVE COMPLICATION; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; REVIEW; RISK ASSESSMENT; RISK REDUCTION; SURGICAL MORTALITY;

ADRENERGIC BETA-ANTAGONISTS; ANESTHESIA; CARDIOTONIC AGENTS; HUMANS; HYDROXYMETHYLGLUTARYL-COA REDUCTASE INHIBITORS; MYOCARDIAL ISCHEMIA; PERIOPERATIVE CARE; RISK ASSESSMENT; SURGICAL PROCEDURES, OPERATIVE;

EID: 34248207330     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/ACO.0b013e3280c60c50     Document Type: Review

References (67)

1. Thom T, Haase N, Rosamond W, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2006 update. Circulation 2006; 113:85-151. This extensive report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee describes the prevalence and incidence of cardiovascular disease in the USA.
2. Mangano DT. Adverse outcomes after surgery in the year 2001 - a continuing odyssey. Anesthesiology 1998; 88:561-564.
3. Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 1995; 333:1750-1756.
4. Bai J, Hashimoto J, Nakahara T, et al. Influence of ageing on perioperative cardiac risk in noncardiac surgery. Age Ageing 2007; 36:68-72. This retrospective study of 1.351 patients evaluated whether increased perioperative cardiac risk in noncardiac surgery is attributable to ageing itself or to the associated cardiac risk factors and coronary artery disease.
5. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297:845-850.
6. Detsky AS, Abrams HB, McLaughlin JR, et al. Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med 1986; 1:211-219.
7. Eagle KA, Coley CM, Newell JB, et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110:859-866.
8. Gilbert K, Larocque BJ, Patrick LT. Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery. Ann Intern Med 2000; 133:356-359.
9. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100:1043-1049.
10. Boersma E, Kertai MD, Schouten O, et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118:1134-1141.
11. Boersma E, Poldermans D, Bax JJ, et al. Predictors of cardiac events after major vascular surgery: role of clinical characteristics, dobutamine echocardiography, and beta-blocker therapy. JAMA 2001; 285:1865-1873.
12. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery - executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002; 105:1257-1267.
13. Mantha S, Roizen MF, Barnard J, et al. Relative effectiveness of four preoperative tests for predicting adverse cardiac outcomes after vascular surgery: a meta-analysis. Anesth Analg 1994; 79:422-433.
14. Shaw LJ, Eagle KA, Gersh BJ, Miller DD. Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. J Am Coll Cardiol 1996; 27:787-798.
15. Kertai MD, Boersma E, Bax JJ, et al. A meta-analysis comparing the prognostic accuracy of six diagnostic tests for predicting perioperative cardiac risk in patients undergoing major vascular surgery. Heart 2003; 89:1327-1334.
16. Kertai MD, Boersma E, Sicari R, et al. Which stress test is superior for perioperative cardiac risk stratification in patients undergoing major vascular surgery? Eur J Vasc Endovasc Surg 2002; 24:222-229.
17. Van Klei WA, Kalkman CJ, Tolsma M, et al. Preoperative detection of valvular heart disease by anaesthetists. Anaesthesia 2006; 61:127-132. This study estimated the prevalence of heart murmurs in 2522 consecutive adult noncardiac surgery patients during preoperative evaluation.
18. Kertai MD, Bountioukos M, Boersma E, et al. Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery. Am J Med 2004; 116:8-13.
19. Karthikeyan G, Bhargava B. Managing patients undergoing noncardiac surgery: need to shift emphasis from risk stratification to risk modification. Heart 2006; 92:17-20. This review article discusses the causes of perioperative cardiac ischemic events and how these can be prevented.
20. Poldermans D, Bax JJ, Schouten O, et al. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo Study Group. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control? J Am Coll Cardiol 2006; 48:964-969. This randomized multicenter study assessed the value of preoperative cardiac testing in intermediate-risk patients receiving β-blocker therapy with tight heart rate control scheduled for major vascular surgery.
21. Kertai MD, Boersma E, Bax JJ, et al. Comparison between serum creatinine and creatinine clearance for the prediction of postoperative mortality in patients undergoing major vascular surgery. Clin Nephrol 2003; 59:17-23.
22. Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345:1359-1367.
23. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998; 339:321-328.
24. Hall C. Essential biochemistry and physiology of (NT-pro)BNP. Eur J Heart Fail 2004; 6:257-260.
25. Yoshimura M, Yasue H, Okumura K, et al. Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 1993; 87:464-469.
26. Yasue H, Yoshimura M, Sumida H, et al. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994; 90:195-203.
27. Lainchbury JG, Campbell E, Frampton CM, et al. Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol 2003; 42:728-735.
28. Bettencourt P, Azevedo A, Pimenta J, et al. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 2004; 110:2168-2174.
29. Schnabel R, Rupprecht HJ, Lackner KJ, et al., AtheroGene Investigators. Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study. Eur Heart J 2005; 26:241-249.
30. Kragelund C, Gronning B, Kober L, et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005; 352:666-675.
31. Yeh HM, Lau HP, Lin JM, et al. Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective noncardiac surgery. Br J Surg 2005; 92:1041-1045.
32. Feringa HH, Bax JJ, Elhendy A, et al. Association of plasma N-terminal pro-Btype natriuretic peptide with postoperative cardiac events in patients undergoing surgery for abdominal aortic aneurysm or leg bypass. Am J Cardiol 2006; 98:111-115. This prospective study found that preoperative plasma natriuretic peptide levels are independently associated with an increased risk of postoperative cardiac events.
33. Dernellis J, Panaretou M. Assessment of cardiac risk before noncardiac surgery: brain natriuretic peptide in 1590 patients. Heart 2006; 92:1645-1650. This study involving 1590 patients found that preoperative brain natriuretic peptide is an independent predictor of postoperative cardiac events.
34. Feringa HH, Schouten O, Dunkelgrun M, et al. Plasma N-terminal pro-B-type natriuretic peptide as long-term prognostic marker after major vascular surgery. Heart 2006; 93:226-231. This prospective study reports the strong predictive value of preoperative N-terminal pro-B-type natriuretic peptide for long-term mortality and major cardiac events after noncardiac vascular surgery.
35. Stone JG, Foex P, Sear JW, et al. Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology 1988; 68:495-500.
36. Wallace A, Layug B, Tateo I, et al. Prophylactic atenolol reduces postoperative myocardial ischemia. McSPI Research Group. Anesthesiology 1998; 88:7-17.
37. Urban MK, Markowitz SM, Gordon MA, et al. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg 2000; 90:1257-1261.
38. Raby KE, Brull SJ, Timimi F, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 1999; 88:477-482.
39. Mangano DT, Layug EL, Wallace A, Tateo I. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335:1713-1720.
40. Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341:1789-1794.
41. Auerbach AD, Goldman L. Beta-Blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA 2002; 287:1435-1444.
42. Devereaux PJ, Beattie WS, Choi PT, et al. How strong is the evidence for the use of perioperative beta blockers in noncardiac surgery? Systematic review and meta-analysis of randomized controlled trials. BMJ 2005; 331:313-321.
43. Yang H, Raymer K, Butler R, et al. The effects of perioperative beta-blockade: results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial. Am Heart J 2006; 152:983-990. This double-blind randomized controlled trial of perioperative metoprolol versus placebo in patients undergoing abdominal aortic surgery and infrainguinal or axillofemoral revascularization showed that metoprolol was not effective in reducing 30-day and 6-month postoperative cardiac event rate.
44. Juul AB, Wetterslev J, Gluud C, et al. Effect of perioperative beta blockade in patients with diabetes undergoing major noncardiac surgery: randomised placebo controlled, blinded multicentre trial. BMJ 2006; 332:1482. This randomized, placebo-controlled, blinded multicenter trial showed no significant benefit of perioperative metoprolol on cardiac morbidity in patients with diabetes undergoing major noncardiac surgery.
45. Task Force on B-blockers of the European Society of Cardiology. Expert consensus document on β-adrenergic receptor blockers. Eur Heart J 2004; 25:1341-1362.
46. Cruickshank JM. Beta-blockers continue to surprise us. Eur Heart J 2000; 21:354-364.
47. Feringa HH, Bax JJ, Boersma E, et al. High-dose beta-blockers and tight heart rate control reduce myocardial ischemia and troponin T release in vascular surgery patients. Circulation 2006; 114:I344-349. This prospective study showed that higher doses of β-blockers and lower perioperative heart rates are associated with reduced perioperative cardiac ischemia and improved long-term outcome.
48. Hoeks SE, Scholte Op Reimer WJ, et al. Increase of 1-year mortality after perioperative beta-blocker withdrawal in endovascular and vascular surgery patients. Eur J Vasc Endovasc Surg 2007; 33:13-19. This prospective survey showed an under-use of β-blocker therapy in vascular surgery patients and demonstrated that perioperative withdrawal of β-blockers was associated with a higher 1-year mortality rate.
49. Biccard BM, Sear JW, Foex P. Acute peri-operative beta blockade in intermediate-risk patients. Anaesthesia 2006; 61:924-931. This systematic review demonstrated that acute β-blockade in the prevention of major cardiovascular complications in intermediate risk nonvascular surgery patients results in an exceedingly high number needed to treat.
50. Feringa HH, Bax JJ, Schouten O, et al. Beta-blockers improve in-hospital and long-term survival in patients with severe left ventricular dysfunction undergoing major vascular surgery. Eur J Vasc Endovasc Surg 2006; 31:351-358. This study showed the beneficial effect of β-blockers on short and long-term outcome in vascular surgery patients with severe left ventricular dysfunction.
51. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004; 39:967-975.
52. Moreno PR, Fuster V. The year in atherothrombosis. J Am Coll Cardiol 2004; 44:2099-2110.
53. Crisby M, Nordin-Fredriksson G, Shah PK, et al. Pravastatin treatment increases collagen content and decreases lipid content, inflammation, metalloproteinases, and cell death in human carotid plaques: implications for plaque stabilization. Circulation 2001; 103:926-933.
54. ASTEROID Investigators. Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 2006; 295:1556-1565. This excellent prospective study showed that high-intensity statin therapy using rosuvastatin 40 mg achieved an average low-density lipoprotein cholesterol of 60.8 mg/dl and increased high-density lipoprotein cholesterol by 14.7%, which resulted in a significant regression of atherosclerosis.
55. Leurs LJ, Visser P, Laheij RJ, et al. Statin use is associated with reduced allcause mortality after endovascular abdominal aortic aneurysm repair. Vascular 2006; 14:1-8. This study reported the results of the EUROSTAR registry demonstrating that the use of statin therapy in patients who underwent endovascular abdominal aortic aneurysm repair is independently associated with reduced overall mortality.
56. Van de Pol MA, Van Houdenhoven M, Hans EW, et al. Influence of cardiac risk factors and medication on length of hospitalization in patients undergoing major vascular surgery. Am J Cardiol 2006; 97:1423-1426. This study showed that in-hospital length of stay of patients who underwent major vascular surgery can be decreased with statin, aspirin and β-blocker therapy.
57. Schouten O, Kok NF, Boersma E, et al. Effects of statins on renal function after aortic cross clamping during major vascular surgery. Am J Cardiol 2006; 97:1383-1385. The findings of this study suggested an association between statin use and preserved renal function after suprarenal aortic clamping.
58. Groschel K, Ernemann U, Schulz JB, et al. Statin therapy at carotid angioplasty and stent placement: effect on procedure-related stroke, myocardial infarction, and death. Radiology 2006; 240:145-151. This retrospective study determined that preprocedural statin therapy is associated with a reduction of stroke, myocardial infarction and death within 30 days after carotid angioplasty and stent placement in patients with symptomatic carotid stenosis.
59. Paraskevas KI, Liapis CD, Hamilton G, et al. Can statins reduce perioperative morbidity and mortality in patients undergoing noncardiac vascular surgery? Eur J Vasc Endovasc Surg 2006; 32:286-293. This comprehensive review summarized the current evidence on statin therapy and its cardioprotective perioperative effects.
60. Kapoor AS, Kanji H, Buckingham J, et al. Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ 2006; 333:1149. This meta-analysis summarized the strength of evidence for use of statins during the perioperative period to reduce the risk of cardiovascular events.
61. Schouten O, Poldermans D, Visser L, et al. Fluvastatin and bisoprolol for the reduction of perioperative cardiac mortality and morbidity in high-risk patients undergoing noncardiac surgery: rationale and design of the DECREASE-IV study. Am Heart J 2004; 148:1047-1052.
62. Oliver MF, Goldman L, Julian DG, et al. Effect of mivazerol on perioperative cardiac complications during noncardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT). Anesthesiology 1999; 91:951-961.
63. Wallace AW, Galindez D, Salahieh A, et al. Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery. Anesthesiology 2004; 101:284-293.
64. Sandham JD, Hull RD, Brant RF, et al. Canadian Critical Care Clinical Trials Group. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003; 348:5-14.
65. Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg 2001; 234:569-571.
66. Rigg JR, Jamrozik K, Myles PS, et al. MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet 2002; 359:1276-1282.
67. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277:1127-1134.