The times, they are a-changin’; a fundamental change to perioperative cardiac risk stratification for noncardiac surgery

摘要

Preoperative cardiac risk stratification for noncardiac surgery was officially formalised with the publication of the American College of Cardiology/American Heart Association Task Force Practice Guidelines in 1996.1 This landmark publication, set the foundation for all subsequent risk stratification guidelines for noncardiac surgery. The guideline was built around three pillars; i) the patient’s risk factors or comorbidities, ii) the patient’s functional capacity and iii) the risk associated with the surgical procedure.1 Despite, the limited evidence to inform these original guidelines, they provided sensible guidance in the management of noncardiac surgical patients at cardiac risk. Subsequent, iterations of the guidelines,2-4 continued to follow and re-inforce the importance of the three pillars identified in the original guidelines.1 Importantly, this philosophical approach to cardiac risk stratification crossed the Atlantic and was adopted in Europe too.5,6