| Abstract | uIntroductionvApproximately one in four Americans (65/239 million) has cardiovascular disease and, of these, nearly 7 million have symptomatic coronary artery disease (CAD). As many as 5 million other patients have asymptomatic or, silent myocardial ischemia. These figures will continue to be high due to the growth of our aging population. The effect on patients undergoing anesthesia and surgery is substantial. Three million of the 20 million (15%) patients undergoing surgery yearly in the United States, have, or are at risk for, CAD. Four million of additional patients are over the age of 65.1) Despite advances in perioperative care, cardiac morbidity and mortality in patients undergoing noncardiac surgery remain unacceptably high, ranging from 2 to 20 %.1-13) Previous solutions of this problem of perioperative cardiac morbidity focused on preoperative identification. These studies, conducted between 1961 and 1976, found that patients with recent myocardial infarction (<6 months) were at particularly high risk of reinfarction (as much as 37%). |
|---|