10. Cardiac Risk Stratification:
Can it ever be good for you?
The risk of a cardiac event in a patient at high
risk undergoing non-cardiac surgery is 3%. The risk of death from
CABG is 3.2%. The risk of a stroke is 3% or more. The risk of
being admitted to a nursing home after CABG is 10%. And the risk
of neurocognitive defects after an on-pump CABG is 95%. The risk
of death for non-cardiac surgery after CABG is 1.5%. So, it is
really difficult for the total risk (3.2% (CABG) + 1.5% (non-cardiac
after CABG) to be less than (3% risk of non-cardiac without CABG).
The patient experiences the total risk of care. That risk includes
the risk of the risk stratification, the risk of the treatment
for the identified risk, and then the risk of the planned non-cardiac
procedure. Total risk is what the patient cares about. What about
a PTCA or PCI, may be they could help?