p.19 抽出テキスト

This is also the case for patients with other diseases known to be associated with a high risk of concomitant undetected or known CVD (Sections 6.8 and 6.11–6.14).

3.3.1.3 Patients with established cardiovascular disease

The surgical procedure has the potential to aggravate the disease and increase morbidity and mortality in patients with established CVD. This may be preventable by implementing appropriate CV risk stratification prior to NCS and individually tailoring peri-operative therapy to reduce the risk.45 If time allows, it is also recommended to optimize guideline-recommended treatment of the disease before NCS. See Section 6 for a detailed discussion of risk assessment and management of patients with known CVD.

N

Management of patients be f o

f f r e non-ca r diac surge r y (NCS)

Accurate histo r y and clinical examination , including standa

, r d lab tests (Class I)

Advise on stopping smoking , optimize guideline-

, r ecommended medical ther a p y (Class I)

p

<65 y ears without a n y CVD/CV risk factors a Patients with established CVD

Low-risk NCS

≥ 65 y ears or with CV risk factors a

Emergent or urgent NCS

N

Time-sensiti v e NCS

Electi v e NCS Ca r diac testing not f easible

f f e

Multidisciplina r y decision of individualized ca r diac testing. If tim e , manage as electi

, v e NCS

Y

Y

None (see section 6)

Intermediate-risk NCS ECG , biomar

, k ers

k k b (Class I)

Functional c a pacity c (Class IIa)

(see section 6)

High-risk NCS ECG , biomar

, k ers

k k b (Class I)

Functional c a pacity c (Class IIa)

+ ca r diolo g y consultation d

(see section 6) Multidisciplinar y decision

None

Intermediate-risk NCS ECG , biomar

, k ers

k k b (Class I)

Functional c a pacity c (Class IIa)

High-risk NCS ECG , biomar

, k ers

k k b (Class I)

Functional c a pacity c (Class IIa)

None

Intermediate-risk NCS

None

High-risk NCS In patients >45 y ea r, conside

, r :

ECG , biomar

, k ers

k k b (Class IIa) Low-risk NCS

Low-risk NCS

Figure 2 Pre-operative assessment before non-cardiac surgery. CV, cardiovascular; CVD, cardiovascular disease; ECG, electrocardiogram; N, no; NCS, non-cardiac surgery. Y, yes; aCV risk factors: hypertension, smoking, dyslipidaemia, diabetes, family history of CVD. bBiomarkers: hs-cTn T/I (Class I) and/ or BNP/NT-proBNP (Class IIa). If pathological, consult a cardiologist. cFunctional capacity based on Duke Activity Status Index (DASI) or the ability to climb two flights of stairs. dFor diagnostic and therapeutic efforts to be considered, see Section 6. eClose follow-up after intervention and subsequent management of heart disease are advised. Downloaded from academic.oup.com/eurheartj/article/43/39/3826/6675076 by guest on 07 October 2026