Guidelines for Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery (JCS 2014) ― Digest Version ―

The first edition of the “Guidelines for Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery” was created in 2002,1 and was revised after five years.2 As more and more elderly patients undergo surgery, and techniques for diagnosis and treatment of cardiovascular disorders have advanced substantially, the second revision has become necessary. In this second revision, the guidelines were revised substantially in terms of the positioning of coronary interventions for patients undergoing non-cardiac surgery, especially those using drug-eluting stents (DES), and aortic stent grafting, and how to use these new techniques with conventional procedures. Guidelines for other cardiovascular disorders were revised to reflect new findings. As the credibility of randomized clinical studies on the perioperative use of beta blockers, such as the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) study,2a was questioned2b and became a major issue, the American College of Cardiology and American Heart Association revised their ACC/AHA guidelines on the perioperative use of beta blockers for patients undergoing noncardiac surgery in August 2014. At the same time, the European Society of Cardiology and the European Society of Anesthesiology also revised their ESC/ESA guidelines on this matter.3,4 The guidelines for the use of beta blockers were revised in this version according to the above guidelines.