Jonathan B. Shammash, MD
Assistant Professor of Medicine,
Director of General Medical Consultation Service,
Department of Medicine,
Weill Medical College of Cornell University,
New York, NY, USA.
Julie M. Gold, BA
Weill Medical College of Cornell University,
New York, NY, USA.
Overview
Cardiovascular complications are the leading cause of morbidity and mortality in patients undergoing major noncardiac surgeries. It is estimated that 20-40% of patients at risk for cardiac events will experience perioperative cardiac ischemia, conferring a nine-fold increase in risk of perioperative cardiac death, myocardial infarction or unstable angina. This is a serious concern in North America. In the United States, about 1.5 of the 30 million patients undergoing noncardiac surgery each year will experience cardiovascular morbidity.1 Since many of these patients have identifiable risk factors for cardiac ischemia, research efforts have been channeled toward finding modifiable risk factors and introducing pharmacological interventions that may offer cardiovascular protection during the perioperative period. Several small clinical trials have examined the perioperative use of nitrates2 and calcium channel blockers,3 but these did not show a significant reduction in the incidence of cardiac ischemic events.
