Coronary Artery Bypass Grafting is Superior to Percutaneous Coronary Intervention in Prevention of Perioperative Myocardial Infarctions During Subsequent Vascular Surgery

Ward, Herbert B.; Kelly, Rosemary F.; Thottapurathu, Lizy; Möritz, Thomas; Larsen, Greg C.; Pierpont, Gordon L.; Santilli, Steve; Goldman, Steven; Krupski, William C.; Littooy, Fred N.; Reda, Domenic J.; McFalls, Edward O.

doi:10.1016/j.athoracsur.2006.03.074

Cited by 84 publications

(43 citation statements)

References 18 publications

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“…Actually, in the substudy of the CARP trial, Ward et al compared clinical outcomes in the patients receiving CABG vs. PCI as prophylaxis for elective vascular surgery and found that compared with the patients with PCI (131 patients), the patients with CABG (91 patients) had fewer MIs despite more diseased vessels in the CABG group and tended to spend less time in the hospital after the vascular operation. The authors concluded that more complete revascularization was accounted for the intergroup differences (46).…”

Section: Coronary Revascularization Before Noncardiac Surgerymentioning

confidence: 99%

Evidence for Preoperative Aspirin Improving Major Outcomes in Patients With Chronic Kidney Disease Undergoing Cardiac Surgery

Yao¹,

Young²,

Liu³

et al. 2015

Annals of Surgery

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Aim of review:Diabetes is a chronic and slowly progressing disease that has a tendency to develop rapidly deteriorating complications such as major adverse cardiovascular events (MACE), especially under the stress of surgery. While clinical strategy to prevent MACE is controversial and uncertain. Method: We conducted a comprehensive review of current clinical strategies in preventing perioperative MACE, in particularly related to diabetic patients. Results: The major findings are: 1) Current clinical studies have demonstrated that coronary artery bypass graft (CABG) is still a better therapy than percutaneous coronary intervention (PCI) on the ground of reducing repeat revascularization, myocardial infarction and death for most diabetic patients with left main-stem and multivessel coronary artery disease who require revascularization, however, it remains to be studied whether coronary revascularization before noncardiac surgery can protect diabetic patients from MACE; 2) There is lack of evidence that intensive or "tight" glycemic control perioperatively can reduce MACE, instead, a moderate or less stringent glucose management probably is safer for patients undergoing surgery;3) The recent results of clinical trials on beta-blockers appear to be disappointing in preventing MACE in surgical patients, including diabetic patients. Meanwhile, the perioperative therapy with statins, angiotensin-converting enzyme inhibitors or multifactorial interventions is promising in preventing MACE in diabetic patients. Summary: Further studies targeted at preventing MACE in diabetic patients undergoing surgery are needed in order to fight this major health problem in perioperative medicine. ABSTRACT

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Section: Coronary Revascularization Before Noncardiac Surgerymentioning

confidence: 99%

Evidence for Preoperative Aspirin Improving Major Outcomes in Patients With Chronic Kidney Disease Undergoing Cardiac Surgery

Yao¹,

Young²,

Liu³

et al. 2015

Annals of Surgery

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show abstract

“…Indeed, in the CARP trial, physicians were allowed to determine which revascularisation procedure to conduct [2]. However, the clinical risk factors of the two revascularisation groups were similar, with the exception of the extent of the coronary revascularisation procedure and the severity of the coronary artery disease, which was significantly worse in the coronary artery bypass grafting cohort [3]. In the DECREASE-V trial there were some guidelines on which revascularisation procedure to select, based on coronary anatomy and the associated possible delay in the index surgical procedure [4].…”

Section: A Replymentioning

confidence: 99%

“…Spectrophotometric interference is present at much lower triglyceride levels, and affects both biochemistry and haematology values. Haemoglobin and platelet count may be erroneously reported as elevated [3]. Pathology laboratories have a variety of methods to assist with the analysis of lipaemic samples.…”

mentioning

confidence: 99%

Possible side effects of Intralipid rescue therapy

Smith

2009

Anaesthesia

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“…A reanalysis of this trial comparing percutaneous coronary intervention with CABG suggested that percutaneous coronary intervention offered no benefit but that coronary artery bypass graft surgery (CABG) might. 18 More recently, the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo V (DECREASE-V) pilot study, a randomized trial of coronary revascularization or not in high-risk patients with demonstrable ischemia, including 3-vessel disease and left main stem disease, before major vascular surgery, showed no benefit for the patients who underwent preoperative revascularization. 19 Again, the method of revascularization strategy was not randomized and was 65% percutaneous coronary intervention versus 35% CABG.…”

Section: Likely Clinical Settingsmentioning

confidence: 99%