On August 26-29, 2022, the annual congress of the European Society of Cardiology (ESC) took place, which this year was held online and in person in Barcelona, Spain. Breaking news in cardiology, results from major studies were presented and discussed, new and updated recommendations for the prevention and treatment of cardiovascular disease were presented. A fundamentally new document published within the framework of the current ESC Congress was Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery.
According to statistics, every year more than 300 million people worldwide undergo major operations, almost 85% of which are non-cardiac interventions. Every year, at least 660,000 serious cardiovascular complications develop due to non-cardiac surgery. The likelihood of their development depends on the characteristics of the patient, the type of surgery, and whether it is planned or urgent. Surgical risk of cardiovascular complications is classified as low (less than 1%), intermediate (1–5%), and high (more than 5%), depending on the likelihood of myocardial infarction, stroke, or death from cardiovascular disease within 30 days. For example, knee surgery is low risk, a kidney transplant is intermediate risk, and a lung transplant is high risk.
In accordance with the published ESC Guidelines, even in apparently healthy people over 65 years of age, a cardiovascular examination is recommended before moderate- to high-risk non-cardiac surgery. The goal of this screening is to prevent cardiovascular complications, including myocardial infarction, stent thrombosis, cardiac arrhythmias, pulmonary embolism, stroke, and death. The published document provides recommendations for preoperative, operative and postoperative care of patients undergoing non-cardiac surgery in order to reduce the likelihood of cardiovascular complications. Smoking cessation more than four weeks before surgery, correction of high blood pressure, dyslipidemia and diabetes are recommended. Patients should be screened for anemia, which should be corrected prior to surgery. If patients are taking medications, in particular anticoagulants, the physician should tell them whether to stop or continue taking these medications.
The guidelines present the specifics of management tactics for patients with various cardiovascular diseases, kidney diseases, diabetes, cancer, obesity and COVID-19.