2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Abstract

All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the guidelines. The report is also available on the ESC website www.escardio.org/Guidelines See the European Heart Journal online for supplementary data that include background information and detailed discussion of the data that have provided the basis of the guidelines.Click here to access the corresponding ESC CardioMed chapters.

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

“…The same is true regarding the preferred mode of anaesthesia. Pre-operative optimization of PAH therapy should be attempted whenever possible (see also the 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery) [364].…”

Study protocol for an observational cohort evaluating incidence and clinical relevance of perioperative elevation of high-sensitivity troponin I and N-terminal pro-brain natriuretic peptide in patients undergoing lung resection

“…Treatment will be at clinician’s discretion considering the patient’s cardiovascular risk factors and available guidelines recommendations. 7 …”

Biomarkers for cardiovascular risk prediction: from pioneering to evidence-based use in clinical practice

“…An ageing population has an increasingly higher risk of cardiovascular complications such as coronary heart disease, stroke, heart failure, peripheral arterial disease and/or aortic disease. Two-thirds of people aged > 60 years and more than 85% of people aged > 85 years have some form of cardiovascular disease (CVD) [1]. Between now and 2050, the number of people in Europe aged 75-84 years is estimated to increase by 60%.…”

“…This interesting study shows a high incidence of MACE in older patients in the first year after visiting the ED with non-cardiac medical complaints, and is the first prospective study evaluating the predictive ability of hs-cTnT and NT-proBNP in this specific population. In comparison, the incidence of MACE in adults aged ≥ 75 years undergoing non-cardiac surgery (NCS) is about 9.5%, and for these patients guidelines recently published by the European Society of Cardiology recommend a careful preoperative evaluation [1,4]. In addition, the biomarkers hs-cTnT and NT-proBNP have also proven to be predictive of adverse outcomes in this NCS patient population, and are therefore included in perioperative risk estimation calculators/scores besides focused history, physical examination, and assessment of functional capacity.…”

“…In addition, the biomarkers hs-cTnT and NT-proBNP have also proven to be predictive of adverse outcomes in this NCS patient population, and are therefore included in perioperative risk estimation calculators/scores besides focused history, physical examination, and assessment of functional capacity. To be more specific: in patients with known CVD, cardiovascular risk factors (including age ≥ 65 years) or symptoms suggestive of CVD, it is recommended to measure hs-cTnT or hs-cTnI (Class I recommendation) before intermediate or high-risk NCS, and it should be considered to measure BNP or NT-proBNP (Class IIa recommendation) [1]. This argues for a better collaboration with anaesthetists.…”