Key result
Routine coronary revascularization fails to reduce perioperative risks in non-cardiac surgery.
Why the study?
Cardiovascular complications occur in about 3% of non-cardiac surgeries, warranting review of cardiovascular risk assessment and complication prevention in patients with coronary heart disease.
How should cardiovascular risk be assessed and managed in patients with coronary heart disease undergoing non-cardiac surgery?
How should cardiovascular risk be assessed and managed in patients with coronary heart disease undergoing non-cardiac surgery?
Routine coronary revascularization does not reduce perioperative risks in non-cardiac surgery, and perioperative management should be individualized based on functional state and surgery risk category.
Supports individualized assessment over routine revascularization; leaves open prospective validation of testing thresholds.
The incidence of cardiovascular complications in non-cardiac surgery is about 3 %. The review presents the data on the assessment of cardiovascular risk (CVR) in non-cardiac surgery. The algorithm of decisionmaking considers the functional state of the patient and the category of CVR of the upcoming surgery. Functional testing is not indicated for patients with low CVR. Stress tests should be considered in high-risk patients if the test results may change the perioperative drug therapy, the method of anesthesia, or the surgical approach. Routine coronary revascularization does not reduce perioperative risks and is used for special indications. Percutaneous coronary intervention and associated dual antiplatelet therapy may delay the timing of non-cardiac operations. Perioperative drug therapy (beta-blockers, aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins) should be prescribed taking into account the individual risk of the patient.
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Панов et al. (2021) conducted a review in Coronary heart disease undergoing non-cardiac surgery. Cardiovascular risk assessment and perioperative management was evaluated. Cardiovascular risk assessment in non-cardiac surgery should consider the patient's functional state and surgical risk, with routine coronary revascularization not reducing perioperative risks.
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