Assessment and reduction of cardiac complications riskin non-cardiac operations: whether there are differencesbetween European and American guidelines in 2014?

Authors: A.N. Sumin, D.A. Sumin

Company: Research Institute for Complex Issues of Cardiovascular Diseases; Sosnovyy bul’var, 6, Kemerovo, 650002, Russian Federation


Keywords: evaluation of cardiac risk noncardiac surgery

Full text:  



One of the actual problems of modern cardiology is the risk evaluation and correction of cardiac complications in noncardiac surgery. This article discusses the results of recent studies, as well as new international recommendations on the subject, presented in 2014. The review compared the recommendations of European Society of Cardiology and American Heart Association, discusses changes in treatment strategies and disputable items. Particularly discussed issues are the place of preventive revascularization, and routine coronary angiography in preoperative risk stratification. This analysis reveals that international guidelines contain no ready-made recipes for all occasions, and can only be the basis for decision-making in specific clinical situations.


  1. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment andmanagement. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur. Heart J. 2014; 35: 2383–431

  2. Fleisher L.A., Fleischmann K.E., Auerbach A.D., Barnason S.A., Beckman J.A., Bozkurt B. et al. 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. J. Am. Coll. Cardiol. 2014; 64 (22): e77–137

  3. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur. Heart J. 2009; 30: 2769–812

  4. Fleisher L.A., Beckman J.A., Brown K.A., Calkins H., Chaikof E.L., Fleischmann K.E. et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 2009; 120 (21): e169–276

  5. Landesberg G., Mosseri M. Prophylactic Pre-Operative Coronary Revascularization. Is the Phoenix Awakening? JACC. 2009; 54 (11): 997–8

  6. Poldermans D., Devereaux P.J. The experts debate: perioperative beta-blockade for noncardiac surgery – proven safe or not? Cleve. Clin. J. Med. 2009; 76 (Suppl. 4): S84–92.

  7. Барбараш Л.С., Сумин А.Н., Барбараш О.Л., Иванов С.В. Оценка и коррекция периоперационного риска сердечно-сосудистых осложнений при некардиальных операциях. Кардиология. 2012; 5: 77–87

  8. Фроловичева И.С., Мозжухина Н.В., Чомахидзе П.Ш., Полтавская А.Ф., Черноусов А.Л., Сыркин В.П. и др. Оценка риска развития сердечно-сосудистых осложнений при некардиологических вмешательствах: основные рекомендации и клинические наблюдения. Кардиология и сердечно-сосудистая хирургия. 2013; 3: 94–100

  9. Monaco M., Stassano P., Di Tommaso L., Pepino P., Giordano A., Pinna G.B. et al. Systematic strategy of prophylactic coronary angiography improves longterm outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. JACC. 2009; 54: 989–96

  10. Illuminati G., Ricco J.-B., Greco C., Mangieri E., Calio F., Ceccanei G. et al. Systematic preoperative coronary angiography and stenting improves postoperative results of carotid endarterectomy in patients with asymptomatic coronary artery disease: a randomised controlled trial. Eur. J. Vasc. Endovasc. Surg. 2010; 39 (2): 139–45

  11. Devereaux P.J., Mrkobrada M., Sessler D.I., Leslie K., Alonso-Coello P., Kurz A. et al. Aspirin in patients undergoing noncardiac surgery. N. Engl. J. Med. 2014; 370: 1494–503

  12. Erasmus Medical Centre. Report on the 2012 follow- up investigation of possible breaches of academic integrity. 2012. Available at: http://cardiobrief.– 2012-10-english-translation.pdf (accessed 10.07.2013)

  13. Bouri S., Shun-Shin M.J., Cole G.D., Mayet J., Francis D.P. et al. Meta-analysis of secure randomized controlled trials of β-blockade to prevent perioperative death in non-cardiac surgery. Heart. 2014; 100 (6): 456–64

  14. Wijeysundera D.N., Duncan D., Nkonde-Price C., Virani S.S., Washam J.B., Fleischmann K.E. et al. Perioperative Beta Blockade in Noncardiac Surgery: A Systematic Review for the 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. J. Am. Coll. Cardiol. 2014; 64 (22): 2406–25

  15. Gallino A., Aboyans V., Diehm C., Cosentino F., Stricker H., Falk E. et al. Non-coronary atherosclerosis. Eur. Heart J. 2014; 35 (17): 1112–9

  16. Сумин А.Н., Безденежных А.В., Евдокимов Д.О., Корок Е.В., Иванов С.В., Моисеенков Г.В. и др. Коронароангиография в оценке кардиоваскулярного риска при операциях на некоронарных сосудистых бассейнах: взгляд кардиолога. Кардиология и сердечно-сосудистая хирургия. 2010; 5: 4–11

  17. Барбараш Л.С., Сумин А.Н., Евдокимов Д.О., Безденежных А.В., Корок Е.В. и др. Роль клинической оценки и коронароангиографии в снижении числа кардиальных осложнений при сосудистых операциях промежуточного и высокого риска. Ангиология и сосудистая хирургия. 2012; 18 (4): 33–41

  18. Gupta P.K., Gupta H., Sundaram A., Kaushik M., Fang X., Miller W.J. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011; 124: 381–7

  19. Bilimoria K.Y., Liu Y., Paruch J.L., Zhou L., Kmiecik T.E., Ko C.Y. et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J. Am. Coll. Surg. 2013; 217: 833–42. e1–3

  20. Davis C., Tait G., Carroll J., Wijeysundera D.N., Beattie W.S. The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients. Can. J. Anaesth. 2013; 60: 855–63

  21. Cohn S.L. Updated guidelines on cardiovascular evaluation before noncardiac surgery: A view from the trenches. Cleve. Clin. J. Med. 2014; 81 (12): 742–51

  22. Чернявский А.М., Карпенко А.А., Рахметов Н.Р., Дюсупов А.А., Масалимов Е.О., Буланов Б.С. и др. Выбор и этапность хирургического вмешательства у больных с инфраренальной аневризмой брюшной аорты при сочетанном поражении коронарного русла и брахиоцефальных артерий. Ангиология и сосудистая хирургия. 2011; 17 (3): 111–9

  23. Wijeysundera D.N., Beattie W.S., Austin P.C., Hux J.E., Laupacis A. et al. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population based cohort study. BMJ. 2010; 340: b5526

  24. Вачев А.Н., Щукин Ю.В., Суркова Е.А., Дмитриев О.В. Медикаментозное ведение пациентов с ИБС перед выполнением операции каротидной эндартерэктомии. Комплексные проблемы сердечно-сосудистых заболеваний. 2013; 4: 83–7

  25. Комитет экспертов ВНОК. Прогнозирование и профилактика кардиальных осложнений вне-сердечных хирургических вмешательств. Национальные рекомендации. Кардиоваскулярная терапия и профилактика. 2011; 6 (прил. 3): 1–28

  26. McFalls E.O., Ward H.B., Moritz T.E., Goldman S., Krupski W.C., Littooy F. et al. Coronary-Artery Revascularization before Elective Major Vascular Surgery. N. Engl. J. Med. 2004; 351: 2795–804

  27. Сумин А.Н., Корок Е.В., Панфилов С.Д., Евдокимов Д.О., Райх О.И., Безденежных А.В. и др. Сопоставление двух стратегий снижения риска кардиальных осложнений при сосудистых операциях: отдаленные результаты. Комплексные проблемы сердечно-сосудистых заболеваний. 2013; 3: 18–25

  28. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 35 (37): 2541–619

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery