Percutaneous coronary intervention revascularization before non-cardiac surgery

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Percutaneous Coronary Intervention Guidelines Microchapters

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 Incorporated with 2007 ACC/AHA Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1] [2]

Revascularization Before Non-cardiac Surgery (DO NOT EDIT)[1] [2]

Class I
" 1. Coronary revascularization before noncardiac surgery is useful in patients with stable angina who have significant left main coronary artery stenosis (Level of Evidence: A) "
" 2. Coronary revascularization before noncardiac surgery is useful in patients with stable angina who have 3-vessel disease (Survival benefit is greater when left ventricular ejection fraction is less than 0.50). (Level of Evidence: A) "
" 3. Coronary revascularization before noncardiac surgery is useful in patients with stable angina who have 2-vessel disease with significant proximal left anterior descending stenosis and either ejection fraction less than 0.50 or demonstrable ischemia on noninvasive testing (Level of Evidence: A)"
" 4. Coronary revascularization before noncardiac surgery is recommended for patients with high-risk unstable angina or non ST-segment elevation myocardial infarction (MI) (Level of Evidence: A) "
" 5. Coronary revascularization before noncardiac surgery is recommended in patients with acuteST elevation MI.(Level of Evidence: A) "
Class III (No Benefit)
" 1. Routine prophylactic coronary revascularizationshould not be performed in patients with stable CAD before noncardiac surgery.[3][4](Level of Evidence: B)"
" 2. Elective non-cardiac surgery should not be performed in the 4 to 6 weeks after balloon angioplasty or BMS implantation or the 12 months after DES implantation in patients in whom theP2Y12 inhibitor will need to be discontinued peri-operatively.[5][6][7][8](Level of Evidence: B)"
Class IIa
" 1. For patients who require PCI and are scheduled for elective non-cardiac surgery in the subsequent 12 months, a strategy of balloon angioplasty, or BMS implantation followed by 4 to 6 weeks of dual antiplatelet therapy (DAPT), is reasonable.[9][10][11][7][12][6][13] (Level of Evidence: B)"
" 2. For patients with drug eluting stent (DES) who must undergo urgent surgical procedures that mandate the discontinuation of dual antiplatelet therapy (DAPT), it is reasonable to continue aspirin if possible and restart the P2Y12 inhibitor as soon as possible in the immediate postoperative period.[11][1](Level of Evidence: C)"
Class IIb
" 1. The usefulness of preoperative coronary revascularization is not well established in high-risk ischemic patients (eg, abnormal dobutamine stress echocardiography with at least 5 segments of wall-motion abnormalities)(Level of Evidence: C) "
" 2. The usefulness of preoperative coronary revascularization is not well established for low-risk ischemic patients with an abnormal dobutamine stress echocardiography (segments 1 to 4). (Level of Evidence: B) "

References

  1. 1.0 1.1 1.2 Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (2007). "ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery". Journal of the American College of Cardiology. 50 (17): 1707–32. doi:10.1016/j.jacc.2007.09.001. PMID 17950159. Retrieved 2012-10-16. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  3. Cinà CS, Devereaux PJ (2006). "Coronary-artery revascularization before elective major vascular surgery. McFalls EO, ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, Pierpont G, Santilli S, Rapp J, Hattler B, Shunk K, Jaenicke C, Thottapurathu L, Ellis N, Reda DJ, Henderson WG. N Engl J Med. 2004; 351: 2795-804". Vascular Medicine (London, England). 11 (1): 61–3. PMID 16669417. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  4. Schouten O, van Kuijk JP, Flu WJ, Winkel TA, Welten GM, Boersma E, Verhagen HJ, Bax JJ, Poldermans D (2009). "Long-term outcome of prophylactic coronary revascularization in cardiac high-risk patients undergoing major vascular surgery (from the randomized DECREASE-V Pilot Study)". The American Journal of Cardiology. 103 (7): 897–901. doi:10.1016/j.amjcard.2008.12.018. PMID 19327412. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  5. Grines CL, Bonow RO, Casey DE, Gardner TJ, Lockhart PB, Moliterno DJ, O'Gara P, Whitlow P (2007). "Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians". Journal of the American College of Cardiology. 49 (6): 734–9. doi:10.1016/j.jacc.2007.01.003. PMID 17291948. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  6. 6.0 6.1 Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, Lindsay J (2004). "Major noncardiac surgery following coronary stenting: when is it safe to operate?". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 63 (2): 141–5. doi:10.1002/ccd.20124. PMID 15390248. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  7. 7.0 7.1 Kałuza GL, Joseph J, Lee JR, Raizner ME, Raizner AE (2000). "Catastrophic outcomes of noncardiac surgery soon after coronary stenting". Journal of the American College of Cardiology. 35 (5): 1288–94. PMID 10758971. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  8. Win HK, Caldera AE, Maresh K, Lopez J, Rihal CS, Parikh MA, Granada JF, Marulkar S, Nassif D, Cohen DJ, Kleiman NS (2007). "Clinical outcomes and stent thrombosis following off-label use of drug-eluting stents". JAMA : the Journal of the American Medical Association. 297 (18): 2001–9. doi:10.1001/jama.297.18.2001. PMID 17488965. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  9. Berger PB, Bell MR, Hasdai D, Grill DE, Melby S, Holmes DR (1999). "Safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement". Circulation. 99 (2): 248–53. PMID 9892591. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  10. Cruden NL, Harding SA, Flapan AD, Graham C, Wild SH, Slack R, Pell JP, Newby DE (2010). "Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery". Circulation. Cardiovascular Interventions. 3 (3): 236–42. doi:10.1161/CIRCINTERVENTIONS.109.934703. PMID 20442357. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  11. 11.0 11.1 Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF (2009). "2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery". Journal of the American College of Cardiology. 54 (22): e13–e118. doi:10.1016/j.jacc.2009.07.010. PMID 19926002. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  12. Reddy PR, Vaitkus PT (2005). "Risks of noncardiac surgery after coronary stenting". The American Journal of Cardiology. 95 (6): 755–7. doi:10.1016/j.amjcard.2004.11.029. PMID 15757604. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)
  13. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB (2003). "Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting". Journal of the American College of Cardiology. 42 (2): 234–40. PMID 12875757. Retrieved 2011-12-08. Unknown parameter |month= ignored (help)

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