Thomas F Whayne1, Sibu P Saha2. 1. Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA. twhayn0@uky.edu. 2. Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.
Abstract
PURPOSE OF REVIEW: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS: High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation. Coronary angiography prior to surgery usually is not indicated since revascularization shows disappointing CV risk reduction results. Due to high association of peripheral arterial disease (PAD) with coronary artery disease (CAD), low ankle-brachial index (ABI) indicates increased CV risk. New perioperative beta blockade has shown disappointing benefit, but if ongoing should be continued. De novo perioperative beta blockade is for the highest CV risk patient undergoing noncardiac vascular surgery. Good evidence supports CV risk reduction from new or existing statin in the perioperative period, especially for the diabetic. Diabetics should also be on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) secondarily, during the perioperative period to decrease 30-day perioperative mortality. Optimal timing of elective noncardiac surgery following a coronary artery event appears to be 180 days with CV risk decreased by a statin and an ACEI or an ARB.
PURPOSE OF REVIEW: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS: High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation. Coronary angiography prior to surgery usually is not indicated since revascularization shows disappointing CV risk reduction results. Due to high association of peripheral arterial disease (PAD) with coronary artery disease (CAD), low ankle-brachial index (ABI) indicates increased CV risk. New perioperative beta blockade has shown disappointing benefit, but if ongoing should be continued. De novo perioperative beta blockade is for the highest CV risk patient undergoing noncardiac vascular surgery. Good evidence supports CV risk reduction from new or existing statin in the perioperative period, especially for the diabetic. Diabetics should also be on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) secondarily, during the perioperative period to decrease 30-day perioperative mortality. Optimal timing of elective noncardiac surgery following a coronary artery event appears to be 180 days with CV risk decreased by a statin and an ACEI or an ARB.
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Authors: Fernando Botto; Pablo Alonso-Coello; Matthew T V Chan; Juan Carlos Villar; Denis Xavier; Sadeesh Srinathan; Gordon Guyatt; Patricia Cruz; Michelle Graham; C Y Wang; Otavio Berwanger; Rupert M Pearse; Bruce M Biccard; Valsa Abraham; German Malaga; Graham S Hillis; Reitze N Rodseth; Deborah Cook; Carisi A Polanczyk; Wojciech Szczeklik; Daniel I Sessler; Tej Sheth; Gareth L Ackland; Martin Leuwer; Amit X Garg; Yannick Lemanach; Shirley Pettit; Diane Heels-Ansdell; Giovanna Luratibuse; Michael Walsh; Robert Sapsford; Holger J Schünemann; Andrea Kurz; Sabu Thomas; Marko Mrkobrada; Lehana Thabane; Hertzel Gerstein; Pilar Paniagua; Peter Nagele; Parminder Raina; Salim Yusuf; P J Devereaux; P J Devereaux; Daniel I Sessler; Michael Walsh; Gordon Guyatt; Matthew J McQueen; Mohit Bhandari; Deborah Cook; Jackie Bosch; Norman Buckley; Salim Yusuf; Clara K Chow; Graham S Hillis; Richard Halliwell; Stephen Li; Vincent W Lee; John Mooney; Carisi A Polanczyk; Mariana V Furtado; Otavio Berwanger; Erica Suzumura; Eliana Santucci; Katia Leite; Jose Amalth do Espirirto Santo; Cesar A P Jardim; Alexandre Biasi Cavalcanti; Helio Penna Guimaraes; Michael J Jacka; Michelle Graham; Finlay McAlister; Sean McMurtry; Derek Townsend; Neesh Pannu; Sean Bagshaw; Amal Bessissow; Mohit Bhandari; Emmanuelle Duceppe; John Eikelboom; Javier Ganame; James Hankinson; Stephen Hill; Sanjit Jolly; Andre Lamy; Elizabeth Ling; Patrick Magloire; Guillaume Pare; Deven Reddy; David Szalay; Jacques Tittley; Jeff Weitz; Richard Whitlock; Saeed Darvish-Kazim; Justin Debeer; Peter Kavsak; Clive Kearon; Richard Mizera; Martin O'Donnell; Matthew McQueen; Jehonathan Pinthus; Sebastian Ribas; Marko Simunovic; Vikas Tandon; Tomas Vanhelder; Mitchell Winemaker; Hertzel Gerstein; Sarah McDonald; Paul O'Bryne; Ameen Patel; James Paul; Zubin Punthakee; Karen Raymer; Omid Salehian; Fred Spencer; Stephen Walter; Andrew Worster; Anthony Adili; Catherine Clase; Deborah Cook; Mark Crowther; James Douketis; Azim Gangji; Paul Jackson; Wendy Lim; Peter Lovrics; Sergio Mazzadi; William Orovan; Jill Rudkowski; Mark Soth; Maria Tiboni; Rey Acedillo; Amit Garg; Ainslie Hildebrand; Ngan Lam; Danielle Macneil; Marko Mrkobrada; Pavel S Roshanov; Sadeesh K Srinathan; Clare Ramsey; Philip St John; Laurel Thorlacius; Faisal S Siddiqui; Hilary P Grocott; Andrew McKay; Trevor W R Lee; Ryan Amadeo; Duane Funk; Heather McDonald; James Zacharias; Juan Carlos Villar; Olga Lucía Cortés; Maria Stella Chaparro; Skarlett Vásquez; Alvaro Castañeda; Silvia Ferreira; Pierre Coriat; Denis Monneret; Jean Pierre Goarin; Cristina Ibanez Esteve; Catherine Royer; Georges Daas; Matthew T V Chan; Gordon Y S Choi; Tony Gin; Lydia C W Lit; Denis Xavier; Alben Sigamani; Atiya Faruqui; Radhika Dhanpal; Smitha Almeida; Joseph Cherian; Sultana Furruqh; Valsa Abraham; Lalita Afzal; Preetha George; Shaveta Mala; Holger Schünemann; Paola Muti; Enrico Vizza; C Y Wang; G S Y Ong; Marzida Mansor; Alvin S B Tan; Ina I Shariffuddin; V Vasanthan; N H M Hashim; A Wahab Undok; Ushananthini Ki; Hou Yee Lai; Wan Azman Ahmad; Azad H A Razack; German Malaga; Vanessa Valderrama-Victoria; Javier D Loza-Herrera; Maria De Los Angeles Lazo; Aida Rotta-Rotta; Wojciech Szczeklik; Barbara Sokolowska; Jacek Musial; Jacek Gorka; Pawel Iwaszczuk; Mateusz Kozka; Maciej Chwala; Marcin Raczek; Tomasz Mrowiecki; Bogusz Kaczmarek; Bruce Biccard; Hussein Cassimjee; Dean Gopalan; Theroshnie Kisten; Aine Mugabi; Prebashini Naidoo; Rubeshan Naidoo; Reitze Rodseth; David Skinner; Alex Torborg; Pilar Paniagua; Gerard Urrutia; Mari Luz Maestre; Miquel Santaló; Raúl Gonzalez; Adrià Font; Cecilia Martínez; Xavier Pelaez; Marta De Antonio; Jose Marcial Villamor; Jesús Alvarez García; Maria José Ferré; Ekaterina Popova; Pablo Alonso-Coello; Ignacio Garutti; Patricia Cruz; Carmen Fernández; Maria Palencia; Susana Díaz; Teresa Del Castillo; Alberto Varela; Angeles de Miguel; Manuel Muñoz; Patricia Piñeiro; Gabriel Cusati; Maria Del Barrio; Maria José Membrillo; David Orozco; Fidel Reyes; Robert J Sapsford; Julian Barth; Julian Scott; Alistair Hall; Simon Howell; Michaela Lobley; Janet Woods; Susannah Howard; Joanne Fletcher; Nikki Dewhirst; C Williams; A Rushton; I Welters; M Leuwer; Rupert Pearse; Gareth Ackland; Ahsun Khan; Edyta Niebrzegowska; Sally Benton; Andrew Wragg; Andrew Archbold; Amanda Smith; Eleanor McAlees; Cheryl Ramballi; Neil Macdonald; Marta Januszewska; Robert Stephens; Anna Reyes; Laura Gallego Paredes; Pervez Sultan; David Cain; John Whittle; Ana Gutierrez Del Arroyo; Daniel I Sessler; Andrea Kurz; Zhuo Sun; Patrick S Finnegan; Cameron Egan; Hooman Honar; Aram Shahinyan; Krit Panjasawatwong; Alexander Y Fu; Sihe Wang; Edmunds Reineks; Peter Nagele; Jane Blood; Megan Kalin; David Gibson; Troy Wildes Journal: Anesthesiology Date: 2014-03 Impact factor: 7.892