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Management Strategies for Noncardiac Surgery Following a Coronary Artery Event

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer?

Recent Findings

High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation. Coronary angiography prior to surgery usually is not indicated since revascularization shows disappointing CV risk reduction results. Due to high association of peripheral arterial disease (PAD) with coronary artery disease (CAD), low ankle-brachial index (ABI) indicates increased CV risk. New perioperative beta blockade has shown disappointing benefit, but if ongoing should be continued. De novo perioperative beta blockade is for the highest CV risk patient undergoing noncardiac vascular surgery. Good evidence supports CV risk reduction from new or existing statin in the perioperative period, especially for the diabetic. Diabetics should also be on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) secondarily, during the perioperative period to decrease 30-day perioperative mortality.

Summary

Optimal timing of elective noncardiac surgery following a coronary artery event appears to be 180 days with CV risk decreased by a statin and an ACEI or an ARB.

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Abbreviations

ABI:

ankle-brachial index

ACEI:

angiotensin-converting enzyme inhibitor

ACS:

acute coronary syndrome

ARB:

angiotensin receptor blocker

BNP:

brain natriuretic peptide

CABG:

coronary artery bypass graft

CAD:

coronary artery disease

CHF:

congestive heart failure

CI:

confidence interval

CTA:

computed tomography angiogram

CV:

cardiovascular

DAPT:

Dual antiplatelet therapy

IHD:

ischemic heart disease

ITE:

isolated troponin elevation

LR:

likelihood ratio

MACCE:

major adverse cardiovascular and cerebrovascular events

MACE:

major adverse cardiac event

METs:

metabolic equivalents

MI:

myocardial infarction

NT-proBNP:

N-terminal-pro brain natriuretic peptide

OR:

odds ratio

PAD:

peripheral arterial disease

PCI:

percutaneous coronary intervention

RCRI:

revised cardiac risk index

SE:

stress echocardiography

TI:

thallium imaging

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Acknowledgments

The authors thank Colleen McMullen, MA, MBA for her excellent editorial critique.

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Authors and Affiliations

  1. Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA

    Thomas F. Whayne Jr & Sibu P. Saha

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Correspondence to Thomas F. Whayne Jr.

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This article is part of the Topical Collection on Ischemic Heart Disease

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Whayne, T.F., Saha, S.P. Management Strategies for Noncardiac Surgery Following a Coronary Artery Event. Curr Cardiol Rep 20, 3 (2018). https://doi.org/10.1007/s11886-018-0948-0

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