Cardiac protection by preoperative intervention in noncardiac surgery

Preoperative coronary intervention is one option to optimize the cardiac risk patient scheduled for noncardiac surgery. Such an intervention, however, is only justified for high risk procedures and if the indication for preoperative intervention is independent from surgery. Currently, PTCA with stent implantation is the most commonly used practice. Dependent of the type of stent (bare-metal stent or drug-eluting stent) dual antiplatelet therapy is mandatory for 1 – 12 months.The surgeon, the cardiologist and the anesthesiologist have to decide in an interdisciplinary approach the perioperative management to navigate the patient between stent thrombosis and surgical bleeding.