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ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management

ESC Clinical Practice Guidelines

Risk Factors and Prevention
Non-cardiac Surgery\Pre-surgical Assessment
Guidelines version available to download
Published in 2014
Reference ESC/ESA Non-Cardiac Surgery Guidelines - Eur Heart J (2014) 35 , 2383–243
Published in 2014
Reference Pocket Guidelines Abriged version
Published in 2014
Reference Pocket Guidelins Mobile App
Published in 2014
Reference 2014 Slides on NCS
Table of contents: Full Text (ESC Clinical Practice Guidelines)

Preamble and introduction

  • The magnitude of the problem
  • Change in demographics
  • Purpose and organization

Pre-operative evaluation

  • Surgical risk for cardiac events
  • Type of surgery
    • Endovascular vs. open vascular procedures
    • Open vs. laparoscopic or thoracoscopic procedures
  • Functional capacity
  • Risk indices
  • Biomarkers
  • Non-invasive testing
    • Non-invasive testing of cardiac disease
    • Non-invasive testing of ischaemic heart disease
  • Invasive coronary angiography

Risk-reduction strategies

  • Pharmacological
    • Beta-blockers
    • Statins 
    • Nitrates
    • angiotensin -converting enzyme inhibitors and angiotensin-receptor blockers 
    • Calcium channel blockers 
    • Alpha2 receptor agonists 
    • Diuretics
  • Peri-operative management in patients on anti-platelet agents
    • Aspirin
    • Dual anti-platelet therapy 
    • Reversal of anti-platelet therapy
  • Peri-operative management in patients on anticoagulants
    • Vitamin K antagonists
    • Non-vitamin K antagonist oral anticoagulants
    • Reversal of anticoagulant therapy
  • Revascularization
    • Prophylactic revascularization in patients with asymptomatic or stable ischaemic heart disease
    • Type of prophylactic revascularization in patients with stable ischaemic heart disease 
    • Revascularization in patients with non-ST-elevation acute coronary syndrome

Specific diseases

  • Chronic heart failure
  • Arterial hypertension
  • Valvular heart disease
    • Patient evaluation 
    • Aortic stenosis 
    • Mitral stenosis
    • Primary aortic regurgitation and mitral regurgitation 
    • Secondary mitral regurgitation 
    • Patients with prosthetic valve(s) 
    • Prophylaxis of infective endocarditis
  • Arrhythmias
    • New-onset ventricular arrhythmias in the pre-operative period 
    • Management of supraventricular arrhythmias and atrial fibrillation in the pre-operative period.
    • Peri-operative bradyarrhythmias 
    • Peri-operative management of patients with pacemaker/implantable cardioverter defibrillator 
  • Renal disease
  • Cerebrovascular disease 
  • Peripheral artery disease 
  • Pulmonary disease 
  • Congenital heart disease

Peri-operative monitoring

  • Electrocardiography
  • Transoesophageal echocardiography 
  • Right heart catheterization
  • Disturbed glucose metabolism 
  • Anaemia


  • Intra-operative anaesthetic management
  • Neuraxial techniques 
  • Peri-operative goal-directed therapy 
  • Risk stratification after surgery 
  • Early diagnosis of post-operative complications 
  • Post-operative pain management

Gaps in evidence