Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery
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DOI：
10.1016/j.cjca.2016.09.008
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发表时间：
2017-01-01
影响因子：
6.2
通讯作者：
Devereaux, P. J.
中科院分区：
文献类型：
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作者：
Duceppe, Emmanuelle;Parlow, Joel;Devereaux, P. J.
加拿大心血管学会指南委员会和加拿大主要意见领袖认为，有必要制定最新的指南，对接受非心脏手术的患者使用建议评估、开发和评价分级（GRADE）证据评估系统。强有力的建议包括：1）测量脑利钠肽（BNP）或proBNP的N-末端片段（NT-proBNP），以增强65岁或以上、45-64岁患有严重心血管疾病或修订的心脏风险指数评分>= 1的患者的围手术期心脏风险估计; 2）反对进行术前静息超声心动图、冠状动脉计算机断层扫描血管造影、运动或心肺运动试验，或药理学负荷超声心动图或放射性核素显像以增强围手术期心脏风险估计; 3）反对开始或继续使用乙酰水杨酸预防围手术期心脏事件，近期冠状动脉支架植入或将接受颈动脉内膜切除术的患者除外; 4）在手术前24小时内开始使用α（2）激动剂或β受体阻滞剂; 5）在手术前24小时开始停用血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂; 6）促进手术前戒烟; 7）在具有升高的NT-proBNP的患者中，在手术后48至72小时测量每日肌钙蛋白，术前BNP测量或如果术前未测量NT-proBNP/BNP，则在修订心脏风险指数评分>= 1、年龄45-64岁且患有显著心血管疾病或年龄65岁或以上的患者中;和8）在手术后遭受心肌损伤/梗塞的患者中开始长期乙酰水杨酸和他汀治疗。
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 alpha(2) agonist or beta-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.