Summary
Over the past 35 yr, approximately 100 outcome studies have examined the problem of PCM in patients undergoing noncardiac surgery. Most have focused on preoperative historical predictors, of which only a recent MI or present CHF are proven predictors of PCM. The efficacy and cost-effectiveness of specialized preoperative cardiac testing, such as exercise stress testing or dipyridamole-thallium imaging, remain controversial. Outcome studies of intraoperative predictors have shown that anaesthetic choice does not affect outcome, but that emergency surgery, major vascular surgery, and prolonged thoracic or upper abdominal surgery are associated with increased risk. Among the dynamic intraoperative risk factors, hypotension and tachycardia appear to predict outcome. Myocardial ischaemia, although potentially important, has not been studied rigorously in patients undergoing noncardiac surgery. Studies of the postoperative period are few. Preliminary data suggest that postoperative risk factors for PCM may be at least as critical as intraoperative factors. There appears to be a high incidence of haemodynamic stresses and of myocardial ischaemia during the postoperative period. However, the relationship of postoperative ischaemia to outcome is, as yet, unknown.
Résumé
Au cours des 35 dernières années, une centaine d’études de résultats ont examiné le problème de la morbidité cardiaque périopératoire chez le patient qui subit une chirurgie autre que cardiaque. La plupart ont porté sur des prédicteurs anamnestiques dont seul l’IM récent ou 1’ICC ont fait leur preuve. L’efficacité et le coût/efficacité des épreuves cardiaques spéciales comme les épreuves d’effort ou l’imagerie au dipyridamole-thallium demeurent controversés. Des études de résultats sur les prédicteurs peropératoires ont montré que le choix de l’anesthésique n’affecte pas le résultat, mais que la chirurgie urgente, la chirurgie vasculaire majeure et les interventions abdominales et thoraciques prolongées sont associées à un risque accru. Parmi les facteurs de risque dynamique, l’hypotension et la tachycardie semblent présager le pronostic. L’ischémie myocardique bien qu’elle soit potentiellement importante n’a pas fait l’objet d’études rigoureuses chez le patients soumis à une chirurgie autre que cardiaque. Les études de la période postopératoire sont peu nombreuses. Des données préliminaires suggèrent que les facteurs de risque postopératoire de morbidité cardiaque périopératoire peuvent être aussi critiques que les facteurs peropératoires. A la période postopératoire, les stress hémodynamiques et l’ischémie myocardique semblent fréquents. Cependant, la relation entre l’ischémie postopératoire et le pronostic est jusqu’à ce jour mal connue.
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Adapted fromMangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–284.
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Mangano, D.T. Perioperative cardiac morbidity. Can J Anaesth 41 (Suppl 1), R13–R19 (1994). https://doi.org/10.1007/BF03009958
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DOI: https://doi.org/10.1007/BF03009958