Murthy Nikitha M, Yoo Thomas T, Sanchez Alyssa, Chhitu Mayur, Abramov Dmitry, Gatling Jason, Mamas Mamas A, Parwani Purvi
Loma Linda University Health, Loma Linda, California, US.
University of California Riverside, Riverside, California, US.
Methodist Debakey Cardiovasc J. 2025 Aug 12;21(4):87-100. doi: 10.14797/mdcvj.1629. eCollection 2025.
Despite medical advances and increased perioperative testing, mortality and cardiovascular complications of noncardiac surgery (NCS) have hardly declined since the early 2000s. Studies demonstrate a disproportionate overutilization of preoperative diagnostic testing with a concurrent underutilization of interventions that have been shown to meaningfully modify mortality. Consequently, there has been a paradigm shift in the approach to perioperative testing. Current thinking advocates for a more judicious and individualized approach-that is, reserving noninvasive testing for select cases at highest risk of periprocedural cardiovascular events, where it may more effectively alter management. Thus, this review provides an update of the latest evidence-based recommendations on preoperative diagnostic assessment of patients with cardiovascular risk factors undergoing NCS, proposes a framework that can be referenced when approaching such a patient in clinical practice, and highlights areas that need more data to guide decision-making in clinical practice.
尽管医学取得了进步，围手术期检查也有所增加，但自21世纪初以来，非心脏手术（NCS）的死亡率和心血管并发症几乎没有下降。研究表明，术前诊断检查存在过度使用的情况，同时，已被证明能显著降低死亡率的干预措施却未得到充分利用。因此，围手术期检查的方法发生了范式转变。目前的观点主张采用更明智、更个性化的方法，即在围手术期心血管事件风险最高的特定病例中保留无创检查，因为在这些病例中，无创检查可能更有效地改变治疗方案。因此，本综述提供了关于接受NCS的心血管危险因素患者术前诊断评估的最新循证建议的更新，提出了一个在临床实践中处理此类患者时可参考的框架，并强调了在临床实践中需要更多数据来指导决策的领域。
