An appraisal of different cardiac risk reduction strategies in vascular surgery patients.
OBJECTIVE
to summarize existing evidence regarding the benefits and the risks of all available interventional and medical means aimed at cardiac risk reduction in patients undergoing vascular surgery.


METHODS
review of the literature.


METHODS
a critical review of all studies examining the impact of various prophylactic cardiac maneuvers on perioperative outcome following vascular surgery was performed. Overall mortality, cardiac mortality and myocardial infarction rate were used as the outcome measures.


RESULTS
coronary artery bypass grafting is associated with a 60% decrease in perioperative mortality in patients undergoing vascular surgery, but in most of the cases this decrease does not outweigh the combined risk of the cardiac and the subsequent noncardiac vascular procedure. Data supporting the cardioprotective effect of percutaneous transluminal angioplasty in the perioperative setting are insufficient. beta-blockade has been shown to decrease perioperative mortality and cardiac morbidity in both high-risk (strong evidence) and low-risk (weak evidence) patients.


CONCLUSIONS
coronary revascularization is rarely indicated to simply get the patient through vascular surgery and should be reserved for patients who would need it irrespective of the scheduled vascular procedure. Among all available pharmacological agents, including beta-blockers, alpha-agonists, calcium channel blockers and nitrates, only beta-blockers have been proven to reduce the cardiac risk of vascular surgery.
Kakisis
J D
JD
Department of Vascular Surgery, Yale University School of Medicine, New Haven, CT 06510, U.S.A.
Abir
F
F
Liapis
C D
CD
Sumpio
B E
BE
D006348:Cardiac Surgical Procedures; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006331:Heart Diseases / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D006801:Humans; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014656:Vascular Surgical Procedures
D002317:Cardiovascular Agents