rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2020-10-08rpcardio-2295Research ArticleASSOCIATED PROBLEMS OF CARDIOLOGYСМЕЖНЫЕ ВОПРОСЫ КАРДИОЛОГИИActual Issues of the Cardiac Complications Risk Assessment and Correction in Non-Cardiac SurgeryАктуальные вопросы оценки и коррекции риска кардиальных осложнений при некардиальных операцияхСуминА. Н.SuminA. N.

Сумин Алексей Николаевич – доктор медицинских наук, заведующий отделом мультифокального атеросклероза

650002, Кемерово, Сосновый бульвар, 6

Alexei N. Sumin – MD, PhD, Chief of Department of Multifocal Atherosclerosis 

Sosnovy Bulvar 6, Kemerovo, 650002 

an_sumin@mail.ruНаучно-исследовательский институт комплексных проблем сердечно-сосудистых заболеванийРоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation202019102020165749758Copyright © Sumin A.N., 20202020Сумин А.Н.Sumin A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2295

Worldwide, more than 200 million non-cardiac surgeries are performed annually, and this number is constantly increasing; cardiac complications are the leading cause of death in such surgeries. So, in a multicenter study conducted in 27 countries, cardiovascular complications were present in 68% of cases of death in the postoperative period. Registers of recent years have shown that the number of such complications remains high, for example, with a dynamic assessment of troponins, perioperative myocardial damage was detected in 13-18% of cases. This review provides a critical analysis of the step-by-step algorithm for assessing cardiac risk of non-cardiac operations considering the emergence of new publications on this topic. The review discusses new data on risk assessment scales, functional state assessment, the use of non-invasive tests, biomarkers, the role of preventive myocardial revascularization in the preoperative period, and drug therapy. The issues of non-cardiac operations after percutaneous coronary intervention, perioperative myocardial damage are considered separately. The review emphasizes the difficulties in obtaining evidence, conducting randomized clinical trials in this section of medicine, which do not allow obtaining unambiguous conclusions in most cases and lead to inconsistencies and ambiguities in the recommendations of various expert groups. This review will help practitioners navigate this issue and help to use the optimal diagnostic and treatment strategy before performing non-cardiac surgery.

Во всем мире ежегодно проводится более 200 миллионов некардиальных операций, это число постоянно возрастает, а ведущей причиной смертности при таких операциях являются кардиальные осложнения. Так, в многоцентровом исследовании, проведенном в 27 странах, кардиоваскулярные осложнения присутствовали в 68% случаев развития летального исхода в послеоперационном периоде. Регистры последних лет показали, что число таких осложнений сохраняется высоким, например, при динамической оценке тропонинов периоперационное повреждение миокарда выявлялось в 13-18% случаев. В настоящем обзоре проведен критический анализ пошагового алгоритма оценки кардиального риска некардиальных операций в свете появления новых публикаций по данной тематике. В обзоре рассмотрены новые данные по шкалам оценки риска, оценки функционального состояния, использования в предоперационном периоде неинвазивных тестов, биомаркеров, роли превентивной реваскуляризации миокарда, медикаментозной терапии. Отдельно рассмотрены вопросы некардиальных операций после чрескожного коронарного вмешательства, периоперационного повреждения миокарда. В обзоре подчеркиваются трудности в получении доказательной базы, проведении рандомизированных клинических исследований в этом разделе медицины, которые в большинстве случаев не позволяют получить однозначных выводов, и приводят к разночтениям и неясностям в рекомендациях различных групп экспертов. Настоящий обзор поможет практическим врачам ориентироваться в данном вопросе, а также формировать оптимальную диагностическую и лечебную стратегию перед выполнением некардиальных операций.

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The authors declare that there are no conflicts of interest present.