Editorials

Safer non-cardiac surgery for patients with coronary artery disease

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7170.1400 (Published 21 November 1998) Cite this as: BMJ 1998;317:1400

Medical treatment should be optimised to improve outcome

  1. Julian Sonksen, Specialist registrar in anaesthesia,
  2. Richard Gray, Director, Birmingham Clinical Trials Unit,
  3. Peter Hutton Hickman, Professor of anaesthesia
  1. Queen Elizabeth Hospital and Birmingham Medical School, Birmingham B15 2TH

    How best to manage patients with coronary artery disease who undergo major non-cardiac surgery is an increasingly important issue as the populationages. Such patients, particularly those with easily induced ischaemia, are at increased risk of perioperative cardiac complications and death.1 Various pre-emptive interventions have beenconsidered to minimise this risk, but often their precise role is poorly defined.

    Coronary artery bypass grafting is effective but carries its own risks, and overall survival benefit is seen only in patients who warrant bypass surgery independently of their major non-cardiac operation.2 These patients, although few, are a well defined3 population who should be offered prophylactic coronary revascularisation. The role of percutaneous transluminal coronary angioplasty is less well defined because, even in the wider populationof patients with coronary artery disease, no prospective randomised trial has shown a prognostic benefit for angioplasty over medical treatment. Use of preoperative angioplasty should therefore be restricted to patients with readily inducible ischaemia, in whom a single coronary stenosis subtends a large area of viable myocardium.4

    Most patients with coronary artery disease presenting for elective …

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