Publié dans Anaesthesia Critical Care & Pain Medicine 2018 August;37(4):313-315
Auteurs : Lattuca B, Cayla G, Montalescot G.
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With the increasing proportion of elderly patients, the prevalence of coronary artery disease (CAD) and, concomitantly, of stented arteries, continue to rise in everyday practice. Thus, the incidence of non-cardiac surgery after coronary stenting is more than 10% at 1 year and more than 20% at 2 years. Both the optimal timing of non-cardiac surgery and the need for continuing chronic antiplatelet therapy to mitigate perioperative major adverse cardiac events have been controversial.
The aim of the review proposed by Fellahi et al. was to evaluate and summarise key messages from clinical practice guidelines addressing the perioperative management of CAD patients who need elective non-cardiac surgery. The peroperative and postoperative periods are generally consensual but there is a considerable variability in clinical practice for the preoperative period due to the low levels of evidence in the international recommendations. In case of urgent non-cardiac surgery, a heart team discussion is necessary but the benefit/risk balance is usually obvious independently of the coronary status. Concerning non-cardiac elective surgery, if we compare the five main and more recent guidelines (French Society of Cardiology/French Society of Anaesthesia and Intensive Care Medicine (SFC/SFAR 2011), American College of Cardiology/American Heart Association (ACC/AHA 2014), European Society of Cardiology/European Society of Anaesthesia (ESC/ESA 2014), ESC guidelines for stable CAD and Canadian Cardiovascular Society (CCS 2017), there are several noteworthy and consensual points.