Major Vascular Complications in Patients Undergoing Non‐Cardiac Surgery: Magnitude of the Problem, Risk Prediction, Surveillance, and Prevention

Worldwide 200 million adults undergo major noncardiac surgery annually, and several million of these patients will suffer a major vascular complication (i.e., vascular death, nonfatal myocardial infarction, nonfatal cardiac arrest, nonfatal stroke) in the first 30 days after surgery. Studies have identified several clinical risk factors (e.g., coronary artery disease, cerebrovascular disease) to help identify patients at risk of a major perioperative vascular complication. A preoperative NT‐proBNP measurement may substantially enhance perioperative vascular risk prediction. Troponin measurements for the first few days after surgery hold great promise as a surveillance strategy to allow physicians to avoid missing the majority of perioperative myocardial infarctions. The results of the POISE Trial, which demonstrated that a perioperative beta‐blocker prevented myocardial infarctions but at a cost of excess strokes and deaths, highlight why large perioperative trials are necessary. There is encouraging evidence that several interventions (e.g., clonidine) may prevent major perioperative vascular complications; however, there is an urgent need for large trials to evaluate these interventions.