title: Coronary Angiography and Revascularization Prior to Noncardiac Surgery.
abstract: The role of coronary angiography and revascularization, including percutaneous coronary intervention (PCI) prior to noncardiac surgery remains poorly defined. The goal of preoperative angiography and PCI is improved risk stratification and ideally risk reduction of postoperative cardiovascular events, such as myocardial infarction (MI). By current guidelines, these procedures should be performed sparingly in high-risk stable coronary artery disease (CAD) patients and routinely in patients with acute coronary syndrome (ACS). Anatomic assessment of CAD by routine invasive angiography is discouraged, although noninvasive assessment may soon be possible. As prior trials have failed to show a clear benefit in outcomes, PCI should only be considered in patients with high-risk anatomic features. The ideal management of other anatomic disease discovered by angiography is currently unknown. Limited registry data suggest that PCI is used more frequently than recommended, although the features of these procedures remain poorly elaborated. In patients who do undergo preoperative PCI, careful attention must be paid to patient-specific factors including the nature and urgency of surgery and duration of dual antiplatelet therapy. In summary, substantial evidence gaps warrant further research in this important area.
authors.affiliation: Departments of Medicine and Radiology, Weill Cornell Medical College, 1305 York Ave, 8th Avenue, New York, NY, 10021, USA. jos9143@med.cornell.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Schulman-Marcus
authors.affiliation: Department of Medicine, New York Presbyterian Hospital, 505 E 70th St, Suite 450, New York, NY, 10021, USA. rap9066@nyp.org.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Pashun
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, 520 E 70th St, New York, NY, 10021, USA. dnf9001@med.cornell.edu.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Greenberg Division of Cardiology, Weill Cornell Medical College, 520 E 70th St, New York, NY, 10021, USA. rvs9001@med.cornell.edu.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
keywords: Cardiac catheterization; Noncardiac surgery; Percutaneous coronary intervention; Preoperative risk assessment