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

Ideal peri‐operative management of patients with cardiovascular disease: the quest continues In this issue of Anaesthesia , Breen and colleagues report that mortality after major vascular surgery was significantly worse in 34 patients who had undergone coronary artery bypass grafting (CABG) within the previous month, compared with those who had undergone CABG 1–2 or 2–3 months previously or had not undergone CABG within 3 months [ 1 ]. The incidences of renal and heart failure were significantly higher and there was a trend towards a higher incidence of non‐fatal myocardial infarction (MI) after major vascular surgery within 1 month of CABG. Furthermore, peri‐operative mortality was significantly higher compared with control patients specifically matched for established peri‐operative cardiovascular risk factors and type of surgery (20.6% vs. 3.9%, respectively). These results appear to contradict the current consensus that, in selected patients, CABG protects against cardiovascular events following subsequent major or high‐risk surgery for 4–6 years, as long as symptoms have not recurred [ 2–4 ]. In the largest single series, the incidence of postoperative deaths in patients undergoing high‐risk non‐cardiac surgery was lower in those who had had prior CABG compared with medical therapy alone (1.7% vs. 3.3%) [ 5 ]. A combined incidence of 1.6% for death or peri‐operative MI http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Wiley

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

Thompson, Dr Jonathan P.
Anaesthesia , Volume 59 (5) – May 1, 2004
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References (59)

Publisher
Wiley
Copyright
Copyright © 2004 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0003-2409
eISSN
1365-2044
DOI
10.1111/j.1365-2044.2004.03804.x
pmid
15096234
Publisher site
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Abstract

In this issue of Anaesthesia , Breen and colleagues report that mortality after major vascular surgery was significantly worse in 34 patients who had undergone coronary artery bypass grafting (CABG) within the previous month, compared with those who had undergone CABG 1–2 or 2–3 months previously or had not undergone CABG within 3 months [ 1 ]. The incidences of renal and heart failure were significantly higher and there was a trend towards a higher incidence of non‐fatal myocardial infarction (MI) after major vascular surgery within 1 month of CABG. Furthermore, peri‐operative mortality was significantly higher compared with control patients specifically matched for established peri‐operative cardiovascular risk factors and type of surgery (20.6% vs. 3.9%, respectively). These results appear to contradict the current consensus that, in selected patients, CABG protects against cardiovascular events following subsequent major or high‐risk surgery for 4–6 years, as long as symptoms have not recurred [ 2–4 ]. In the largest single series, the incidence of postoperative deaths in patients undergoing high‐risk non‐cardiac surgery was lower in those who had had prior CABG compared with medical therapy alone (1.7% vs. 3.3%) [ 5 ]. A combined incidence of 1.6% for death or peri‐operative MI

Journal

Anaesthesia – Wiley

Published: May 1, 2004

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