Document Detail


The role of myocardial revascularization preceding noncardiac surgery.
MedLine Citation:
PMID:  9585373     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Of about 6.7 million Americans who have coronary artery disease, approximately 700,000 undergo various noncardiac operations annually in the United States. Perioperative cardiac complications remain the leading cause of morbidity and mortality not related to the primary operative procedure; the mechanisms of perioperative ischemia and infarction are unclear. Currently, clinicians, using a combination of clinical and laboratory findings, can estimate the risk of noncardiac surgical procedures with a high degree of precision, but much less is known about the preferred approach to patient management after noninvasive risk stratification. Coronary angiography and revascularization are frequently recommended for those determined by functional tests to be at moderate and high risk, but the risks of revascularization are often substantially higher among these patients. No randomized, controlled trials exist to guide patient management. Quantitative decision analysis based on published nonrandomized data suggests that coronary angiography with selective myocardial revascularization should be performed to reduce the risk of noncardiac surgery only if the risk of noncardiac surgery is greater than 5% and the risk of coronary angiography with selective revascularization is less than 3%. On the other hand, if independent indications exist for myocardial revascularization, it should generally be performed before the noncardiac operation.
Authors:
C S Rihal
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Progress in cardiovascular diseases     Volume:  40     ISSN:  0033-0620     ISO Abbreviation:  Prog Cardiovasc Dis     Publication Date:    1998 Mar-Apr
Date Detail:
Created Date:  1998-05-21     Completed Date:  1998-05-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376442     Medline TA:  Prog Cardiovasc Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  383-404     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms
Comorbidity
Coronary Disease / complications*,  diagnosis,  epidemiology,  therapy*
Cost-Benefit Analysis
Decision Trees
Female
Humans
Male
Mass Screening
Middle Aged
Myocardial Revascularization*
Patient Selection
Preoperative Care / methods*
Risk Factors
Treatment Outcome
United States / epidemiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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