Ideal peri‐operative management of patients with cardiovascular disease: the quest continues

Thompson, Jonathan P.

doi:10.1111/j.1365-2044.2004.03804.x

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Cited by 4 publications

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2005

British Journal of Anaesthesia

180

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Perioperative myocardial infarction (PMI) is one of the most important predictors of short- and long-term morbidity and mortality associated with non-cardiac surgery. Prevention of a PMI is thus a prerequisite for an improvement in overall postoperative outcome. The aetiology of PMI is multifactorial. The perioperative period induces large, unpredictable and unphysiological alterations in coronary plaque morphology, function and progression, and may trigger a mismatch of myocardial oxygen supply and demand. With many diverse factors involved, it is unlikely that one single intervention will successfully improve cardiac outcome following non-cardiac surgery. A multifactorial, step-wise approach is indicated. Based on increasing knowledge of the nature of atherosclerotic coronary artery disease, and in view of the poor positive predictive value of non-invasive cardiac stress tests, and the considerable risk of coronary angiography and coronary revascularization in high-risk patients, the paradigm is shifting from an emphasis on extensive non-invasive preoperative risk stratification to a combination of selective non-invasive testing and aggressive pharmacological perioperative therapy. Perioperative plaque stabilization by pharmacological means may be as important in the prevention of PMI as an increase in myocardial oxygen supply or a reduction in myocardial oxygen demand.

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Anaesthesia for lower limb revascularization

Tovey

Thompson

2005

Continuing Education in Anaesthesia Critical Care & Pain

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Ideal peri‐operative management of patients with cardiovascular disease: the quest continues

Cited by 4 publications

References 52 publications

Peri-operative Care of the Vascular Patient

Peri-operative Care of the Vascular Patient

Perioperative myocardial infarction—aetiology and prevention

Anaesthesia for lower limb revascularization

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