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Difficult Decisions in Vascular Surgery pp 501–512Cite as

In Patients Undergoing Vascular Surgery, Does Preoperative Coronary Revascularization Reduce the Risk of Myocardial Infarction and Death?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Tens of millions of surgical procedures are performed annually in the United States and the world over. A significant proportion of these procedures are associated with perioperative adverse cardiac events and these in turn, increase cardiovascular morbidity and mortality. Perioperative myocardial infarction, variably defined in the historical literature, may in fact occur in greater than 1 in 10 post-surgical patients by current definitions. Preoperative risk assessment may be carried out using a variety of validated risk prognostication models. While guideline-driven medical therapies form the foundation of risk reduction in patients undergoing noncardiac surgery, high-risk findings on non-invasive assessment may necessitate coronary angiography. Whereas coronary revascularization is widely accepted as the standard of care in preoperative patients with acute coronary syndromes or acute myocardial infarction, the practice of routine preoperative coronary revascularization for the purpose of cardiac risk reduction, is neither supported by the available trial data nor endorsed by the U.S. and European clinical practice guidelines, even in patients undergoing high risk noncardiac surgeries. Despite this, contemporary registry data bears out the wide usage of preoperative coronary revascularization. Small European studies have hinted at benefit associated with a strategy of routine coronary angiography and when necessary, percutaneous revascularization, in high-risk patients pending vascular operations. However these reports have yet to be confirmed in large-scale, randomized, multicenter trials. Unanswered questions remain regarding the optimal duration of dual antiplatelet therapy and timing of surgery in patients who have had prior percutaneous coronary revascularization.

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Authors and Affiliations

  1. Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Chicago, IL, USA

    Rohan Kalathiya MD, Atman Shah MD & Sandeep Nathan MD, MSc

Authors
  1. Rohan Kalathiya MD
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  2. Atman Shah MD
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  3. Sandeep Nathan MD, MSc
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Correspondence to Sandeep Nathan MD, MSc .

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Editors and Affiliations

  1. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Christopher L. Skelly

  2. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Ross Milner

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Kalathiya, R., Shah, A., Nathan, S. (2017). In Patients Undergoing Vascular Surgery, Does Preoperative Coronary Revascularization Reduce the Risk of Myocardial Infarction and Death?. In: Skelly, C., Milner, R. (eds) Difficult Decisions in Vascular Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-33293-2_42

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  • DOI: https://doi.org/10.1007/978-3-319-33293-2_42

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  • Online ISBN: 978-3-319-33293-2

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