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British Journal of Anaesthesia, 2004, Vol. 92, No. 5 628-632
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial II

Prevention of cardiac complications of non-cardiac surgery: stenosis and thrombosis

D. E. Newby and A. F. Nimmo*

Departments of Cardiology and Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK

*Corresponding author. E-mail: a.nimmo@ed.ac.uk

The first 150 words of the full text of this article appear below.

In this issue of the British Journal of Anaesthesia, Marcucci and colleagues1 present a case report of ‘prophylactic’ preoperative coronary stenting in a patient undergoing lung resection. This case was associated with a fatal postoperative myocardial infarct because of in-stent thrombosis, despite waiting 6 weeks between the coronary intervention and surgery as recommended in the ACC/AHA guidelines on perioperative cardiovascular evaluation for non-cardiac surgery.2 The case report appropriately questions the wisdom of prophylactic coronary stenting a few weeks before non-cardiac surgery and suggests the use of alternative strategies to reduce the risk of cardiac complications.

Stenosis and thrombosis

There is no definitive evidence that percutaneous coronary intervention improves prognosis in patients with coronary artery disease except in the context of primary angioplasty for acute myocardial infarction.3 Randomized controlled trials in patients with chronic stable angina have demonstrated that coronary angioplasty is an excellent method of reducing coronary arterial luminal stenoses and anginal . . . [Full Text of this Article]

Preoperative prophylactic revascularisation

Perioperative prophylactic medical therapy

Beta blockers
Statins
Antiplatelet therapy
Antithrombin therapy
ACE inhibition
Conclusions

Declaration of interest


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