Karthikeyan G, Bhargava B
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Heart. 2006 Jan;92(1):17-20. doi: 10.1136/hrt.2004.057125.
Many patients undergo non-invasive testing for the detection of coronary artery disease before non-cardiac surgery. This is despite the low predictive value of positive tests in this population and the lack of any evidence of benefit of coronary revascularisation before non-cardiac surgical procedures. Further, this strategy often triggers a clinical cascade exposing the patient to progressively riskier testing and intervention and results in increased costs and unnecessary delays. On the other hand, administration of beta blockers, and more recently statins, has been shown to reduce the occurrence of perioperative ischaemic events. Therefore, there is a need for a shift in emphasis from risk stratification by non-invasive testing to risk modification by the application of interventions, which prevent perioperative ischaemia--principally, perioperative beta adrenergic blockade and perhaps treatment with statins. Clinical risk stratification tools reliably identify patients at high risk of perioperative ischaemic events and can guide in the appropriate use of perioperative medical treatment.
许多患者在非心脏手术前会接受用于检测冠状动脉疾病的非侵入性检查。尽管此类检查在这一人群中的阳性预测价值较低，且没有任何证据表明在非心脏手术前进行冠状动脉血运重建有益。此外，这种策略常常引发一系列临床情况，使患者面临风险越来越高的检查和干预，导致成本增加和不必要的延误。另一方面，已证明使用β受体阻滞剂以及最近使用他汀类药物可减少围手术期缺血事件的发生。因此，需要将重点从通过非侵入性检查进行风险分层转向通过应用干预措施来改变风险，这些干预措施可预防围手术期缺血——主要是围手术期β肾上腺素能阻滞剂，或许还有他汀类药物治疗。临床风险分层工具能够可靠地识别围手术期缺血事件高危患者，并可指导围手术期药物治疗的合理使用。
