Risk stratification

Question 1

Goals of risk stratification

Answer 1

testing to change LONG-term cardiac complication risk
Delay surgery for testing
Delay surgery for coronary revasc or valve replacement
Change proposed procedure

Question 2

Baseline risks of surgery age > 40

Answer 2

Periop MI = 1.4%
Death 1%

Question 3

Surgeries with higher baseline risk of mortality, MACE or stroke

Answer 3

Vascular, thoracic & transplant sx

Question 4

Additional rIsk factors for patients with CVD including PVD, stroke

Answer 4

1) 5x higher incidence of LVEF < 40%
2) Higher coronary disease
3) Increased susceptibility to surgical stress: ischemia from blood loss, inc myocardial O2 demand from fluid shifts & hypotension, inc platelet reactivity

Question 5

Risk of death & MI after surgery categories

Answer 5

Mortality < 1%, ambulatory
Mod 1-5%
High >5%

Question 6

Rationale for preop ECG

Answer 6

Have baseline for comparison postop (NOT diagnosis)

Question 7

RCRI Reconstructed RCRI

Answer 7

• Surgical site:intraabdominal, intrathoracic, vascular above umbilicus
• CAD history
• CHF history stroke history
• CrCl < 30 instead of Cr > 176
• Insulin-dependent diabetes

Question 8

Other factors increasing risk

Answer 8

Increasing age, increasing ASA classification, low functional status
Afib
Obesity (BMI > 40? 35?)

Question 9

N-Terminal pro-BNP

Answer 9

Increased RCRI accuracy thresholds**?

Question 10

Brain Naturietic Peptide (BNP)