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<p>During major noncardiac procedures (NCS), patients with diabetes mellitus (DM) carry an increased risk of peri- and postoperative complications including myocardial infarction and mortality. This risk is mainly determined by two factors: the patient-related risk and the intervention-related risk, i.e., the type of procedure or intervention, and the circumstances in which it takes place (institutional expertise, elective vs. emergency setting). Particularly high is the risk in patients aged &gt; 65&#xa0;years, patients with additional cardiovascular risk factors besides DM, or patients with established cardiovascular disease (CVD). Baseline diagnosis includes assessment of patient history, physical examination, electrocardiogram (ECG), and biomarkers. Functional capacity should also be assessed. In addition, an echocardiogram and, when necessary, exercise testing with imaging should be performed. Perioperative management of long-term therapy for common comorbidities, e.g., arterial hypertension, heart failure, coronary artery disease (CAD), and renal insufficiency, should be discussed in a&#xa0;multidisciplinary team. For the perioperative handling of pre-existing antithrombotic therapy with antiplatelet agents and oral anticoagulants, special attention is required. Diabetic patients with valvular diseases (primarily aortic stenosis), symptomatic heart failure, arrhythmias (especially bradyarrhythmias), pulmonary hypertension, peripheral artery disease (PAD), cerebrovascular occlusive disease, and cardiac implantable electronic devices (CIEDs) should receive perioperative cardiologic follow-up.</p>

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Perioperatives Management von Menschen mit Diabetes mellitus: Kardiologie

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Volker Klauss

摘要

During major noncardiac procedures (NCS), patients with diabetes mellitus (DM) carry an increased risk of peri- and postoperative complications including myocardial infarction and mortality. This risk is mainly determined by two factors: the patient-related risk and the intervention-related risk, i.e., the type of procedure or intervention, and the circumstances in which it takes place (institutional expertise, elective vs. emergency setting). Particularly high is the risk in patients aged > 65 years, patients with additional cardiovascular risk factors besides DM, or patients with established cardiovascular disease (CVD). Baseline diagnosis includes assessment of patient history, physical examination, electrocardiogram (ECG), and biomarkers. Functional capacity should also be assessed. In addition, an echocardiogram and, when necessary, exercise testing with imaging should be performed. Perioperative management of long-term therapy for common comorbidities, e.g., arterial hypertension, heart failure, coronary artery disease (CAD), and renal insufficiency, should be discussed in a multidisciplinary team. For the perioperative handling of pre-existing antithrombotic therapy with antiplatelet agents and oral anticoagulants, special attention is required. Diabetic patients with valvular diseases (primarily aortic stenosis), symptomatic heart failure, arrhythmias (especially bradyarrhythmias), pulmonary hypertension, peripheral artery disease (PAD), cerebrovascular occlusive disease, and cardiac implantable electronic devices (CIEDs) should receive perioperative cardiologic follow-up.