ESC 2022 Non-cardiac Surgery

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

The 2022 ESC guideline replaces reflexive preoperative testing with a risk-stratified pathway built on the surgical risk category, functional capacity and biomarkers, and it introduces myocardial injury after non-cardiac surgery (MINS) as a diagnosis in its own right. Much of its evidence is negative — the trials below are as important for what they stopped as for what they started.

This guideline cites 5 of the 199 landmark trials in our Cardiology register.

Source
Halvorsen S, Mehilli J, et al. Eur Heart J. 2022;43(39):3826–3924. · European Heart Journal

Perioperative beta-blockade1

  • 2008POISECardiology · Cardioprotection · Beta-blockadePeriOperative ISchemic Evaluation trial

Perioperative antithrombotic therapy3

  • 2022POISE-3Cardiology · Cardioprotection · Antifibrinolytic therapyPeriOperative ISchemic Evaluation-3 trial
  • 2018MANAGECardiology · Cardioprotection · Antithrombotic therapyManagement of myocardial injury After NoncArdiac surGEry trial
  • 2014POISE-2Cardiology · Cardioprotection · Aspirin and clonidinePeriOperative ISchemic Evaluation-2 trial

Preoperative revascularisation1

  • 2004CARPCardiology · Cardioprotection · Preoperative revascularisationCoronary Artery Revascularization Prophylaxis trial