Assessment of patients before operation can reduce the risk

Decisions about the cardiac risk of a surgical procedure may be taken by the surgeon, anaesthetist, cardiologist, referring doctor, or general practitioner. All need to make informed judgments about the perioperative risk, yet despite advances in anaesthesia and surgical techniques the prediction of risk remains an uncertain science.

The leading cause of death after surgery is myocardial infarction.1 Non-fatal myocardial infarction accounts for considerable morbidity2; it may be silent in a quarter of cases, and (not surprisingly) it is associated with a poor outcome. Yet 17 years after Goldman et al developed a clinical risk score in an attempt to predict which patients would develop cardiac complications3 we are not aware of any prospective trial in Britain intended to measure the incidence of perioperative infarction. Trials in North America have reported rates of serious cardiac complications ranging from 1.7% to 40%.4 These data have been used to justify strategies as various as no attempt at predicting risk and routine preoperative coronary angiography in high risk subsets such as patients with peripheral vascular disease.5 Assessment of the extent of …