Jeffrey L. Anderson, MD, FACC, FAHA, Chair 

Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect 

Nancy M. Albert, PhD, RN, FAHA

Biykem Bozkurt, MD, PhD, FACC, FAHA

Ralph G. Brindis, MD, MPH, MACC

Lesley H. Curtis, PhD, FAHA

David DeMets, PhD[¶¶][1]

Lee A. Fleisher, MD, FACC, FAHA

Samuel

/pdf/2014-acc-aha-guideline-on-perioperative-cardiovascular-3firuin78y.pdf

2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American college of cardiology/American heart association task force on practice guidelines

http://umg.umdnj.edu/gim/consult_manual/Poise%20Trial%202008,%20ACC%20guidelines%202006.pdf

Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial.

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Preamble 2216

1 Introduction 2217

2 Clinical Risk Factors: Recommendations 2220

3 Approach to Perioperative Cardiac Testing 2221

4 Supplemental Preoperative Evaluation: Recommendations 2221

5 Perioperative Therapy: Recommendations 2224

6 Anesthetic Consideration and Intraoperative Management: Recommendations 2228

7 Surveillance and Management for Perioperative MI: Recommendations 2229

8 Future Research Directions 2230

Appendix 1 Author Relationships With Industry and Other Entities (Relevant) 2237

Appendix 2 Reviewer Relationships With Industry and Other Entities (Relevant) 2239

Appendix 3 Related Recommendations From Other CPGs 2244

References 2230

The American College of Cardiology (ACC) and the American Heart Association (AHA) are committed to the prevention and management of cardiovascular diseases through professional education and research for clinicians, providers, and patients Since 1980, the ACC and AHA have shared a responsibility to translate scientific evidence into clinical practice guidelines (CPGs) with recommendations to standardize and improve cardiovascular health These CPGs, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality …

http://cardiacanaesthesia.in/assets/img/guidelines/Perioperative-Cardiovascular-Evaluation-and-Management-of-Patients-Undergoing-Noncardiac-Surgery.pdf

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary

Background: Each year, millions of patients worldwide have a perioperative myocardial infarction (MI) after noncardiac surgery. Objective: To examine the characteristics and short-term outcome of perioperative MI. Design: Cohort study. (ClinicalTrials.gov registration number: NCT00182039) Setting: 190 centers in 23 countries. Patients: 8351 patients included in the POISE (PeriOperative ISchemic Evaluation) trial. Measurements: Four cardiac biomarker or enzyme assays were measured within 3 days of surgery. The definition of perioperative MI included either autopsy findings of acute MI or an elevated level of a cardiac biomarker or enzyme and at least 1 of the following defining features: ischemic symptoms, development of pathologic Q waves, ischemic changes on electrocardiography, coronary artery intervention, or cardiac imaging evidence of MI. Results: Within 30 days of random assignment, 415 patients (5.0%) had a perioperative MI. Most MIs (74.1 %) occurred within 48 hours of surgery; 65.3% of patients did not experience ischemic symptoms. The 30-day mortality rate was 11.6% (48 of 415 patients) among patients who had a perioperative MI and 2.2% (178 of 7936 patients) among those who did not (P < 0.001). Among patients with a perioperative MI, mortality rates were elevated and similar between those with (9.7%; adjusted odds ratio, 4.76 [95% CI, 2.68 to 8.43]) and without (12.5%; adjusted odds ratio, 4.00 [CI, 2.65 to 6.06]) ischemic symptoms. Limitation: Cardiac markers were measured only until day 3 after surgery, and additional asymptomatic MIs may have been missed. Conclusion: Most patients with a perioperative MI will not experience ischemic symptoms. Data suggest that routine monitoring of troponin levels in at-risk patients is needed after surgery to detect most MIs, which have an equally poor prognosis regardless of whether they are symptomatic or asymptomatic.

Characteristics and Short-Term Prognosis of Perioperative Myocardial Infarction in Patients Undergoing Noncardiac Surgery: A Cohort Study

Rationale,design,and organization of the PeriOperative ISchemic Evaluation(POISE) Trial:A randomized controlled trial of metoprolol versus placebo in patients undergoing noncardiac surgery

Victor M Monteri

Papers

Rationale,design,and organization of the PeriOperative ISchemic Evaluation(POISE) Trial:A randomized controlled trial of metoprolol versus placebo in patients undergoing noncardiac surgery