Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000600013
Brazilian Journal of Anesthesiology
Review Article

Aspectos relevantes da doença arterial coronariana em candidatos à cirurgia não cardíaca

Relevant aspects of coronary artery disease in candidates for non-cardiac surgery

Gilson Cassem Ramos

Downloads: 0
Views: 1037

Resumo

JUSTIFICATIVA E OBJETIVOS: Devido à sua prevalência, a doença arterial coronariana (DAC) constitui a principal causa de morbimortalidade em cirurgias eletivas, o que justifica a presente revisão, cujo objetivo foi principalmente estabelecer condutas pré-operatórias baseadas em normas e diretrizes para minimizar a morbimortalidade peri e pós-operatória dos portadores de DAC. CONTEÚDO: São apresentadas características gerais da DAC, assim como seus mecanismos fisiopatogênicos, as principais variáveis relacionadas ao preparo pré-operatório de pacientes com DAC, bem como condutas frente aos enfermos de maior risco cirúrgico. CONCLUSÕES: Portadores de DAC candidatos à cirurgia não cardíaca devem ser rigorosamente avaliados. Os identificados como de alto risco podem beneficiar-se com testes pré-operatórios provocativos de isquemia miocárdica, assim como de intervenções coronarianas invasivas, precedendo operações cirúrgicas eletivas. Em pacientes selecionados, deve-se considerar o uso de betabloqueador e de estatinas .

Palavras-chave

AVALIAÇÃO PRÉ-OPERATÓRIA, CIRURGIA, FATORES DE RISCO

Abstract

BACKGROUND AND OBJECTIVES: Due to its prevalence, coronary artery disease (CAD) represents the main cause of morbidity and mortality in elective surgeries, which justifies this review, whose objective was to establish preoperative conducts based on rules and directive to minimize peri- and postoperative morbidity and mortality of patients with CAD. CONTENTS: General characteristics of CAD, as well as its physiopathogenic mechanisms, the main variables related to preoperative care of patients with CAD, and the conducts for patients with greater surgical risk are presented. CONCLUSIONS: Patients with CAD who are candidates for non-cardiac surgeries should be evaluated judiciously. Those identified as being at high risk can benefit from preoperative myocardial ischemia-provoking tests, as well as from invasive coronary interventions preceding elective surgeries. In selected patients, one should consider the use of beta-blockers and statins.

Keywords

PREOPERATIVE EVALUATION, RISK FACTORS, SURGERY

References

Ferreira JFM, Timerman A. Diagnóstico e estratificação de risco na sala de emergência. Rev Soc Cardiol Est São Paulo. 2007;3:243-56.

Mangano DT. Perioperative cardiac morbidity. Anesthesiology. 1990;72:153-184.

Mangano DT, Wong MG, London MJ. Perioperative myocardial ischemia in patients undergoing noncardiac surgery: II. Incidence and severity during the first week after surgery. J Am Coll Cardiol. 1991;17:851-857.

Poldermans D, Bax JJ, Schouten O. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control?. J Am Coll Cardiol. 2006;48:964-969.

Landesberg G, Mosseri M, Shatz V. Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. J Am Coll Cardiol. 2004;44.

Gibbons RJ, Abrams J, Chatterjee K. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article: a report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee on the Management of Patients with Chronic Stable Angina). J Am Coll Cardiol. 2003;41:159-168.

Hernandez AF, Newby LK, OConnor CM. Preoperative evaluation for major noncardiac surgery: focusing on heart failure. Arch Intern Med. 2004;164:1729-1736.

Mangano DT, Goldman L. Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med. 1995;333:1750-1756.

Goldman L, Hashimoto B, Cook EF. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227-1234.

Batlouni M. O Sistema Cardiovascular em Situações Especiais. Tratado de Cardiologia SOCESP. 2005:1506-1519.

Eagle KA. Surgical patients with heart disease: summary of the ACC/AHA guidelines. Am Fam Physician. 1997;56:811-818.

Fleisher LA, Beckman JA, Brown KA. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50:e159-e241.

Auerbach A, Goldman L. Assessing and reducing the cardiac risk of noncardiac surgery. Circulation. 2006;113:1361-1376.

Mattos LA, Lemos Neto PA, Rassi A Jr. Diretrizes da Sociedade Brasileira de Cardiologia: Intervenção Coronária Percutânea e Métodos Adjuntos Diagnósticos em Cardiologia Intervencionista (II Edição - 2008). Arq Bras Cardiol. 2008;91:1-58.

Hoffmann R, Mintz GS, Dussaillant GR. Patterns and mechanisms of in-stent restenosis: A serial intravascular ultrasound study. Circulation. 1996;94:1247-1254.

Sousa JE, Costa MA, Abizaid A. Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2001;103:192-195.

Sousa JE, Costa MA, Abizaid A. Sirolimus-eluting stent for the treatment of in-stent restenosis: a quantitative coronary angiography and three-dimensional intravascular ultrasound study. Circulation. 2003;107:24-27.

Stettler C, Wandel S, Allemann S. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network metaanalysis. Lancet. 2007;370:937-948.

Laskey WK, Yancy CW, Maisel WH. Thrombosis in coronary drugeluting stents: report from the meeting of the Circulatory System Medical Devices Advisory Panel of the Food and Drug Administration Center for Devices and Radiologic Health, December 7-8, 2006. Circulation. 2007;115:2352-2357.

Silber S, Albertsson P, Avilés FF. Guidelines for percutaneous coronary interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804-847.

King SB 3rd, Smith SC Jr, Hirshfeld JW Jr. Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation. 2007;117:261-295.

Fleisher LA, Beckman JA, Brown KA. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007;50:1707-1732.

Bavry AA, Lincoff AM. Is clopidogrel cardiovascular medicine's double-edged sword?. Circulation. 2006;113:1638-1640.

O'Neill WW. Risk of bleeding after elective percutaneous coronary intervention. N Engl J Med. 2006;355:1058-1060.

Devereaux PJ, Yang H, Yusuf S. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839-1847.

Caramelli B, Pinho C, Calderano D. I Diretriz de Avaliação Pré-operatória. Arq Bras Cardiol. 2007;88:e139-e178.

5dcea4df0e8825f051bf58f1 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections