Postoperative risk stratification for cardiovascular complications

Abstract

Current evidence suggests that myocardial oxygen supplydemand imbalance predominates in the early postoperative period. It is likely that flow stagnation and thrombus formation is an important pathway in the development of a perioperative myocardial infarction, in addition to the more commonly recognised role of perioperative tachycardia.¹ Perioperative myocardial infarction is most likely to occur in patients with significant coronary artery stenoses. The impetus to continue to risk stratify into the postoperative period is driven by the fact that the independent predictors of cardiovascular risk change from the preoperative to the postoperative period. Adding independent intraoperative risk factors to preoperative risk prediction models reduces the significance of traditional preoperative risk factors. Only a history of stroke^2-4 and renal dysfunction^3-6 appear to remain as independent predictors, once the intraoperative predictors were added to the models.