Does coronary revascularization make noncardiac surgery safer?\u00a0 If so, when?
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\nOn the cardiology consult service today, we evaluated a man who needs a \u201clow risk\u201d gastrointestinal surgical procedure urgently.\u00a0 He presented to hospital admission with a prolonged hypotensive episode associated with anterior ST depression and mildly elevated troponin levels and\u00a0without chest pain. He had a 3-vessel CABG in 2004 and has been chest pain-free since.<\/p>\n
The anesthesiologist and surgeon ordered a persantine thallium test (results pending) and a cardiology consult. Regardless of what the\u00a0nuclear perfusion test shows, the anesthesiologist and surgeon are \u201cuncomfortable\u201d with performing surgery without defining his coronary anatomy and graft patency (i.e., \u201cWhat harm is there in looking at his coronaries?\u201d)<\/p>\n
Two studies (McFalls et al, NEJM 2004;351:2795-804<\/a> and Poldermans et al, J Am Coll Cardiol 2007:49:1763-9<\/a>) show that preoperative revascularization does not reduce the risk of death or nonfatal MI following noncardiac surgery. Does coronary revascularization make noncardiac surgery safer?\u00a0 If so, when? \u00a0 On the cardiology consult service today, we evaluated a man who needs a \u201clow risk\u201d gastrointestinal surgical procedure urgently.\u00a0 He presented to hospital admission with a prolonged hypotensive episode associated with anterior ST depression and mildly elevated troponin levels and\u00a0without chest pain. He had […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9,16],"tags":[],"class_list":["post-1324","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","category-vascular"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1324","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=1324"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/1324\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=1324"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=1324"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=1324"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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\nIs cardiac catheterization in this patient simply defensive medicine?\u00a0 Do the data support such an approach?\u00a0 Are the previous studies of revascularization prior to non cardiac surgery relevant to our practice today?<\/p>\n","protected":false},"excerpt":{"rendered":"