Perioperative Cardiac Risk Assessment and Management

Perioperative cardiac risk assessment encompasses the systematic evaluation of a patient’s likelihood of experiencing adverse cardiac events in the setting of non-cardiac surgery. This process begins with stratification of baseline risk factors, including age, comorbidities such as ischaemic heart disease or heart failure, functional capacity and the invasiveness of the planned procedure. Commonly employed tools integrate clinical indices, biomarkers and, in selected cases, cardiopulmonary exercise testing to gauge reserve and predict complications. Biomarkers such as natriuretic peptides and troponin guide the identification of subclinical myocardial injury. Intraoperative management focuses on tailored haemodynamic strategies to maintain adequate perfusion pressure, employing goal-directed fluid therapy and vasopressor support guided by advanced monitoring or predictive algorithms. Postoperative surveillance with serial troponin measurements and electrocardiography enables early detection of myocardial injury and informs escalation of care. Multidisciplinary collaboration between anaesthetists, surgeons and cardiologists is essential to individualise optimisation, implement prophylactic measures such as β-blockade or statins when indicated, and plan postoperative monitoring or intensive care admission. Globally, harmonising definitions of cardiovascular endpoints and disseminating practical risk-reduction protocols aims to reduce variation in care and improve outcomes across diverse health-care settings.

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Perioperative Cardiac Risk Assessment and Management publication trend

The graph below shows the total number of articles in perioperative cardiac risk assessment and management across all publications each year (not limited to Nature Index journals).

Technical terms

Functional capacity: A measure of a patient’s ability to perform physical activity, often estimated by questionnaires or cardiopulmonary exercise testing to predict perioperative complications.

Myocardial injury after non-cardiac surgery (MINS): Elevation of cardiac troponin due to ischaemic aetiology within 30 days of surgery, irrespective of clinical symptoms.

Cardiopulmonary exercise testing (CPET): A non-invasive evaluation of cardiovascular and respiratory reserve by measuring oxygen consumption and carbon dioxide production during graded exercise.

Hypotension Prediction Index (HPI): A machine-learning-derived algorithm that analyses arterial waveform features to anticipate episodes of low mean arterial pressure, enabling proactive haemodynamic management.

Goal-directed fluid therapy: A strategy using dynamic haemodynamic parameters to tailor intravenous fluid administration and vasoactive support, aiming to optimise cardiac output and tissue perfusion.

References

1. A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery. Anesthesia & Analgesia (2017).
2. Systematic review and consensus definitions for the Standardized Endpoints in Perioperative Medicine (StEP) initiative: cardiovascular outcomes. British Journal of Anaesthesia (2020).
3. The Use of the Hypotension Prediction Index Integrated in an Algorithm of Goal Directed Hemodynamic Treatment during Moderate and High-Risk Surgery. Journal of Clinical Medicine (2021).