Coronary artery revascularization prior to abdominal nonvascular surgery.
BACKGROUND
Does preoperative revascularization of the myocardium reduce cardiac risk in noncardiac surgery? The aim of this study was to evaluate the clinical effectiveness of preoperative cardioprotection by coronary artery revascularization in abdominal nonvascular surgery under general anesthesia.


METHODS
The observational clinical study included 111 consecutive patients with angiographically verified coronary artery disease. Two stratification groups of patients were compared, those with coronary artery revascularization (34 patients, 30.6%) and those without coronary artery revascularization (77 patients, 64.9%), in relation to frequency of perioperative cardiac complications. The patients were followed up until the 30th postoperative day. During operation and in the following 72 postoperative hours, the patients were monitored by continuous ST-T segment recording. Twelve-lead electrocardiography was performed immediately after surgery and on postoperative days 1, 2, and 7 as well as 1 day before discharge. Serum troponin T levels were controlled at 6, 24, and 96 h postoperatively.


RESULTS
The number of patients with major cardiac complications was 0 (0.0%, n=34) in the revascularized myocardium group and 10 (12.9%, n=77) in the nonrevascularized myocardium group (P<.05). Three patients in the nonrevascularized myocardium group died of acute myocardial infarction, congestive heart failure, and malignant arrhythmias, respectively, with severe coronary artery stenosis verified angiographically.


CONCLUSIONS
Preoperative cardioprotection by coronary artery revascularization significantly reduces morbidity and mortality in patients who have undergone abdominal nonvascular surgery. Patients with severe coronary artery stenosis and indication for coronary artery revascularization independently of noncardiac surgery should first undergo cardiosurgical intervention prior to elective abdominal nonvascular surgery.
Karapandzic
Vesna M
VM
Intensive Care Unit, Department of Surgery, Institute of Digestive System Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia. vemika@eunet.yu
Vujisic-Tesic
Bosiljka D
BD
Colovic
Radoje B
RB
Masirevic
Vesna P
VP
Babic
Dragan D
DD
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000768:Anesthesia, General; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D017558:Elective Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T