Cardiology Consultation in Noncardiac Surgery

All patients undergoing non-cardiac surgery are at risk of major perioperative cardiovascular events. Cardiac complications account for 42% of the overall complications of these surgeries. Therefore, cardiologists are the most frequently consulted specialists in preoperative evaluation. Unnecessary cardiology consultations may cause comments that will not affect the practice of anesthesia, inappropriate tests and interventions, and delay in the surgical procedure. Recently, a predictive model has been developed to assess the risk of myocardial infarction or cardiac arrest (MICA) during and after surgery using the American Society of Surgeons' National Surgical Quality Improvement Program (NSQIP) database. In this MICA model, 180 hospital databases were used in 2007 and 2008 and included more than 200 000 patients. The Gupta score developed with this MICA model identified five predictors of perioperative myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine increase (\>130 mmol/L or \>1.5 mg/dL), age, and American Association of Anesthesiologists (ASA) class. The Gupta score is presented as an interactive risk calculation program in the 2014 guideline of the ACC/AHA. The risk can be calculated simply and accurately at the bedside or clinic. The Gupta score is in spreadsheet format and can be downloaded online at http://www.surgicalriskcalculator.com/miorcardiacarrest. Unlike the previously used indexes, a scoring system has not been established. An estimate of the probability of myocardial infarction/cardiac arrest is provided for individual patients.