Abstract
Coronary revascularisation has been a topic of debate for over three decades in patients undergoing high-risk non-cardiac surgery. The paradigm shifted from routine coronary angiography toward stress test guided decision-making based on larger randomised trials. However, this paradigm is challenged by relatively newer data where routine coronary angiography and revascularisation is shown to improve perioperative cardiovascular outcomes. We review major studies performed over a long period including more contemporary data with regard to the 2014 American College of Cardiology/American Heart Association as well as 2014 European Society of Cardiology guideline on perioperative cardiovascular evaluation of patients undergoing non-cardiac surgery.
Highlights
Cardiac risk stratification before any non-cardiac surgery is a common reason for a cardiology consultation
CA coronary angiography, CR coronary revascularisation, AAA abdominal aortic aneurysm, Vasc vascular, CEA carotid endarterectomy, LM left main, 3vCAD three vessel coronary artery disease, VD vessel disease, Revasc revascularisation, CABG coronary artery bypass grafting, PC percutaneous coronary intervention, REV revascularisation, PMI perioperative non-fatal myocardial infarction, MACE major adverse cardiac events, ST stress test aTotal patients randomised to each group
The results demonstrated that routine coronary angiography followed by prophylactic coronary revascularisation reduced the incidence of postoperative cardiac ischaemic events [12]
Summary
Cardiac risk stratification before any non-cardiac surgery is a common reason for a cardiology consultation. These guidelines recommend the use of risk factor indices (such as the Revised Cardiac Risk Index (RCRI) and National Surgical Quality Improvement Program (NSQIP) risk calculator) and functional capacity of individual patients to guide further testing in preoperative evaluation in patients at elevated risk (>1 %) of perioperative major adverse cardiac events during planned non-cardiac surgery. The purpose of this review is to delineate the pathophysiological basis of perioperative myocardial ischaemia as well as review contemporary studies on perioperative assessment with particular emphasis on revascularisation vis-a-vis the current ACC/AHA guidelines
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