Key result
Routine use of prophylactic coronary angiography and revascularization before noncardiac surgery is not supported by current evidence and should be reserved for acute coronary syndromes or refractory angina.
Why the study?
Does prophylactic myocardial revascularization reduce perioperative cardiovascular complications in patients undergoing noncardiac surgery?
Does prophylactic myocardial revascularization reduce perioperative cardiovascular complications in patients undergoing noncardiac surgery?
Routine preoperative coronary angiography and prophylactic revascularization are not recommended before noncardiac surgery and should be reserved for patients with acute coronary syndromes or refractory symptoms.
Preoperative cardiac assessment may guide optimization before noncardiac surgery; leaves open the optimal testing thresholds in routine practice.
The preoperative evaluation of patients candidates to noncardiac surgery requires a knowledge of factors related both to type of surgery and to features of the single patient, potentially responsible for perioperative cardiovascular complications , fatal and nonfatal. The assessment of symptoms and/or noninvasive testing indicating the presence of coronary artery disease may suggest the need for medical therapy optimization and, eventually, coronary arteriography before the scheduled timing of noncardiac surgery. There is no evidence favoring a prophylactic myocardial revascularization (percutaneous or surgical) and more studies are needed to define the role of coronary artery disease diagnosis and treatment before high-risk non cardiac surgery.
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Lombardi et al. (2017) conducted a review in Preoperative cardiac risk in noncardiac surgery. Prophylactic coronary angiography and revascularization vs. Optimal medical therapy or no prophylactic revascularization was evaluated. Routine use of prophylactic coronary angiography and revascularization before noncardiac surgery is not supported by current evidence and should be reserved for acute coronary syndromes or refractory angina.
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