The unresolved issues with risk stratification and management of patients with coronary artery disease undergoing major vascular surgery

摘要: Purpose: The purpose of this article, with a specific focus on patients undergoing vascular surgery, is to review controversial issues related mechanisms perioperative myocardial infarction (MI), coronary artery disease detection, and strategies reduce complications. We propose explanations for the many conflicting results that have recently emerged in literature. Source documents: searched MEDLINE reviewed all relevant manuscripts scientific statements regarding management non-cardiac surgery. Principal findings: Identification prevention ischemia surgery remains controversial. While identification preoperative marker higher risk, value identifying such has been questioned. believe may be, at least part, due our limited understanding MI. Appropriate patients, based testing, likely key improving outcomes, deserves further investigation. Efforts aimed reducing ischemic consequences severe plaques (by revascularization or -blocker therapy) yielded results. use high doses therapy be harmful. Some studies suggest promising role statin therapy. Benefits acetylsalicylic acid must weighted against risk bleeding. Conclusion: Many questions remain unanswered about impact detecting inducible ischemia, -blockers A better pathophysiology MI critical, order identify best approach improve cardiac outcomes these patients.