Key result
Preoperative coronary revascularization in cardiac-stable patients undergoing elective major vascular surgery does not appear to provide additional benefit in reducing perioperative and long-term mortality compared to medical management.
Why the study?
Does preoperative coronary revascularization reduce perioperative cardiac complications in patients with coronary artery disease undergoing major vascular surgery?
Does preoperative coronary revascularization reduce perioperative cardiac complications in patients with coronary artery disease undergoing major vascular surgery?
This review summarizes the controversial role of preoperative coronary revascularization for reducing perioperative cardiac complications in patients undergoing major vascular surgery.
Supports deferring revascularization for medical therapy in stable patients; leaves open role in higher-risk or contemporary cohorts.
Patients undergoing vascular surgery are at increased risk for perioperative cardiac complications related to the frequent prevalence of underlying coronary artery disease. Cardiac evaluation and noninvasive tests may often identify patients at increased cardiac risk in whom coronary angiography is often considered with subsequent coronary revascularization for the purpose of improving perioperative and long-term cardiac outcomes. However, there has been controversy as to the indications and efficacy for type of revascularization and how coronary revascularization may add to the effect of optimized medical therapy for the reduction of cardiac complications. The aim of this review is to summarize the role of preoperative coronary revascularization in the reduction of perioperative cardiac complications in patients with coronary artery disease undergoing major vascular surgery.
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Kertai et al. (2009) conducted a review in Coronary artery disease in patients undergoing major vascular surgery. Preoperative coronary revascularization vs. No revascularization or optimized medical therapy was evaluated. Preoperative coronary revascularization in cardiac-stable patients undergoing elective major vascular surgery does not appear to provide additional benefit in reducing perioperative and long-term mortality compared to medical management.
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