Perioperative ischaemia and management of patients with coronary stents: current practice.
Keywords:
Coronary, Myocardial ischaemia, Perioperative, Stents.Abstract
Perioperative ischaemia is a common cause of cardiac morbidity and cardiac death during perioperative period in patient with coronary artery disease or with other risk factors. The incidence of perioperative ischaemia is about 20 to 70% in patient with coronary artery disease or coronary artery disease risk factors. Post operative cardiac events (the combined incidence of nonfatal myocardial infarction, unstable angina, heart failure and sudden cardiac death) vary between 5.5 to 53% and postoperative myocardial infarction varies between 1.4 to 43%. Prolonged ST segment depression along with hypercoagulability caused by surgical stress, platelet activation, increased fibrinogen activity and decreased fibrinolytic activities may lead to coronary thrombosis, ischaemia, nonfatal infarction or sudden cardiac death. Patients with coronary stents especially before complete endothelialization of the stents are of high risk category for these complications. Anesthesiologist being a perioperative physician should understand safety issues of these patients to prevent from ischaemia, coronary thrombosis and subsequent infarction or sudden cardiac death. Risk identification, optimization, monitoring, diagnosis of the problem, prevention and management are very crucial during perioperative period to enhance the quality service and patient safety.
References
2. Monago DT. Perioperative Cardiac Morbidity. Anesthesiology 1990;72:153-84.
3. Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005;173:627-634.
4. Jonathan BM. Multimodal Detection of Perioperative Myocardial Ischaemia. Tex Heart Inst J 2005;32:461-6.
5. Priebe HJ. Triggers of Perioperative Myocardial Ischaemia and Infarction. Br J Anaesthesia 2004;93:9-20.
6. Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE Jr, Ettinger SM, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;57:e215-367.
7. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleishmann KE, et al. ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. 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). Circulation 2007;116:e418-99.
8. Landesberg G. Pathophysiology of perioperative myocardial infarction: facts and perspectives. Cardiothorac vasc Anesth 2003;17:90-100.
9. Shrestha N, Limbu D, Siddiqui A. Interventional Cardiology Services . In: Baidya SG, Rajbanshi BG, Prajapati D, editors. Annual Report 2013, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal. Shahid Gangalal National Heart Centre; 2013. p. 25-27.
10. Steinhubl SR, Berger PB, Mann JT III, Fry ETA, DeLago A, Wilmer G, Topol RJ. Clopidogrel for the reduction of events during observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention:a randomized controlled trial. JAMA 2002;288:2411-20.
11. Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery - a prospective outcome study. Br J Anaesth 2006;96:686-93.
12. Chassot PG, Delabays A, Spahn DR. Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth 2007;99:316-28.
13. Seung-Jung P, Duk-Woo P, Young-Hak K, Soo-Jin K, Seon-Whang L, Cheol-Whan L, et al. Duration of Dual Antiplatelet Therapy after Implantation of Drug - Eluting Stents. N Engl J Med 2010;362:1374-82.
14. Hawn MT, Graham LA, Richman JS, Itani KM, Henderson WG, Maddox TM. Risk of Major Cardiac Events Following Noncardiac Surgery in Patients With Coronary Stents. JAMA 2013;310:1462-72.
15. Luskie M, Khattar RS, Fraser D. Non-cardiac Surgery and antiplatelet therapy following coronary artery stenting. Heart 2009;95:1303-08.
16. Broad L, Lee T, Conroy M, Bolsin S, Orford N, Black A, Birdsey G. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth 2007;98:19-22.
17. Frishman WH, Burns B, Atac B, Alturk N, Altajar B, Lerrick K. Novel antiplatelet therapies for treatment of patients with ischemic heart disease: inhibitors of the platelet glycoprotein IIb/IIIa integrin receptor. Am Heart J 1995;130:877-92.
18. Faulds D, Sorkin EM. Abciximab (c7E3 Fab). A review of its pharmacology and therapeutic potential in ischemic heart disease. Drugs 1994;48:583-98.
19. Kleiman NS.Pharmacokinetics and pharmacodynamics of glycoprotein IIb-IIIa inhibitors. Am Heart J 1999;138:263-75.
20. Abualsaud AO, Eisenberg MJ. Perioperative management of the patients with drug eluting stents. JACC Cardiovasc interv 2010;3:131-42.
21. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ 2000;321:1493.
22. Borg T, Modig J. Potential anti-thrombotic effects of local anaesthetics due to their inhibition of platelet aggregation. Acta Anaesthesiol Scand 1985;29:739-42.
23. Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, et al. Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Reg Anesth Pain Med 2003;28:172-97.
24. Newsome LT, Weller RS, Gerancher JC, Kutcher MA, Royster RL. Coronary artery stents: II. Perioperative consideration and management. Anesthesia and analgesia 2008;107:570-90.
25. Angiolillo DJ, Capranzano P. Pharmacology of emerging novel platelet inhibitors. Am Heart J 2008;156:S10-5.
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
