Rise and fall of preoperative coronary revascularization

ABSTRACT

Introduction

About 234 million major surgical procedures are performed each year worldwide, of which >60 million surgeries are performed in the United States. Though postoperative major adverse cardiac complications are relatively low, patients with postoperative myocardial infarction have higher in-hospital mortality. Thus, comprehensive cardiac evaluations, and in some cases, elective coronary revascularizations, are performed prior to surgery with an intent to minimize these complications. In 2009, approximately 4% of all elective percutaneous coronary interventions were performed in preparation for noncardiac surgery.

Areas covered

We discuss relevant articles from the last 50 years regarding elective preoperative coronary revascularization prior to noncardiac surgery.

Expert opinion

In the early years there was an interest in preemptive revascularization to reduce postoperative cardiac events; however, subsequent studies in patients with stable coronary artery disease have mostly shown that a strategy of routine prophylactic coronary revascularization prior to noncardiac surgery does not reduce postoperative cardiac complications.

KEYWORDS:

• Cardiac risk assessment
• noncardiac surgery
• coronary artery disease
• prophylactic coronary revascularization
• preoperative cardiac evaluation

Article Highlights

• Theoretically, preemptive coronary revascularization could reduce postoperative cardiac events after noncardiac surgery. However, the data suggest that in asymptomatic patients with coronary artery disease, prophylactic coronary revascularization prior to noncardiac surgery does not reduce postoperative cardiac complications. Current guidelines recommend against routine revascularization for asymptomatic patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.