Schulman-Marcus Joshua, Pashun Raymond A, Feldman Dmitriy N, Swaminathan Rajesh V
Departments of Medicine and Radiology, Weill Cornell Medical College, 1305 York Ave, 8th Avenue, New York, NY, 10021, USA.
Department of Medicine, New York Presbyterian Hospital, 505 E 70th St, Suite 450, New York, NY, 10021, USA.
Curr Treat Options Cardiovasc Med. 2016 Jan;18(1):3. doi: 10.1007/s11936-015-0427-5.
The role of coronary angiography and revascularization, including percutaneous coronary intervention (PCI) prior to noncardiac surgery remains poorly defined. The goal of preoperative angiography and PCI is improved risk stratification and ideally risk reduction of postoperative cardiovascular events, such as myocardial infarction (MI). By current guidelines, these procedures should be performed sparingly in high-risk stable coronary artery disease (CAD) patients and routinely in patients with acute coronary syndrome (ACS). Anatomic assessment of CAD by routine invasive angiography is discouraged, although noninvasive assessment may soon be possible. As prior trials have failed to show a clear benefit in outcomes, PCI should only be considered in patients with high-risk anatomic features. The ideal management of other anatomic disease discovered by angiography is currently unknown. Limited registry data suggest that PCI is used more frequently than recommended, although the features of these procedures remain poorly elaborated. In patients who do undergo preoperative PCI, careful attention must be paid to patient-specific factors including the nature and urgency of surgery and duration of dual antiplatelet therapy. In summary, substantial evidence gaps warrant further research in this important area.
冠状动脉造影和血运重建的作用，包括在非心脏手术前进行经皮冠状动脉介入治疗（PCI），目前仍不明确。术前血管造影和PCI的目标是改善风险分层，并理想地降低术后心血管事件的风险，如心肌梗死（MI）。根据目前的指南，这些操作应在高危稳定型冠状动脉疾病（CAD）患者中谨慎进行，而在急性冠状动脉综合征（ACS）患者中应常规进行。不鼓励通过常规侵入性血管造影对CAD进行解剖学评估，尽管非侵入性评估可能很快成为可能。由于先前的试验未能在结果中显示出明显益处，PCI仅应在具有高危解剖特征的患者中考虑。目前尚不清楚通过血管造影发现的其他解剖疾病的理想管理方法。有限的登记数据表明，PCI的使用频率高于推荐频率，尽管这些操作的特征仍未详细阐述。在确实接受术前PCI的患者中，必须仔细关注患者特异性因素，包括手术的性质和紧迫性以及双联抗血小板治疗的持续时间。总之，大量证据空白需要在这一重要领域进行进一步研究。
