Non-cardiac surgery in patients with coronary artery disease: risk evaluation and periprocedural management

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Anesthesiology

Background:

• Perioperative cardiovascular complications are significant causes of morbidity and mortality in non-cardiac surgery patients, especially those with coronary artery disease (CAD).
• While preoperative cardiac risk assessment is crucial, over-evaluation can delay surgery and waste resources.
• Optimal perioperative strategies for CAD patients remain uncertain due to conflicting data.

Purpose of the Study:

• To review current data on preoperative risk stratification for patients with CAD undergoing non-cardiac surgery.
• To summarize periprocedural management strategies for these patients, including those with coronary stents.
• To address the dilemma of managing antiplatelet therapy in patients requiring non-cardiac surgery.

Main Methods:

• Literature review of current data and guidelines.
• Analysis of risk factors for thrombotic and bleeding events.
• Discussion of perioperative management strategies for antiplatelet therapy.

Main Results:

• Conflicting data exists regarding the best perioperative strategies for CAD patients.
• Antithrombotic agents increase bleeding risk while being essential for preventing ischemic events.
• 5-25% of patients with coronary stents need non-cardiac surgery within 2 years, often leading to premature cessation of dual antiplatelet therapy.

Conclusions:

• Current guidelines lack detailed recommendations for perioperative antiplatelet management in CAD patients undergoing non-cardiac surgery.
• Balancing thrombotic and bleeding risks is a key clinical challenge.
• Further research is needed to determine the optimal approach for these patients.