Lowering cardiac risk by preoperative interventions.
Postoperative myocardial infarction still represents a serious complication in patients with coronary artery disease, after the first 48 hours following non cardiac surgery (NCS). To reduce the incidence, patient's status should be optimised, including CABG, PTCA and stenting, before the NCS. Indications for CABG, PTCA and stenting suggested by ACC/AHA are in general applicable also for NCS. Patients undergoing low and intermediate risk procedures would not benefit from extensive testing and CABG, while a potential benefit exists for high risk surgery in severe CAD patients. Revascularisation by means of PTCA seems to decrease the risk only if it is performed more than 90 days before the NCS. By the contrary, the combination of PTCA and stenting reduces incidence of coronary re-stenosis, but it increases bleeding, thrombosis and distal embolisation, especially if not supported by an anti-platelet or combined pharmacological schedule; therefore, perioperative stenting is not recommended to increase safety. Moreover, if NCS is urgent, despite a recent stenting, the patient should be included in a high risk group.
Metzler
H
H
Department of Anaesthesiology and Intensive Care Medicine, University of Graz, Graz, Austria. helfried.metzler@uni-graz.at
D015906:Angioplasty, Balloon, Coronary; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D006801:Humans; D011300:Preoperative Care; D015607:Stents