冠心病行非心脏手术患者术前冠状动脉造影和血运重建策略

Strategies for preoperative coronary angiography and revascularization in patients with coronary heart disease undergoing non-cardiac surgery

冠心病行中高风险非心脏手术患者术前常规行冠状动脉造影与血运重建的目的是改善风险分层、降低围术期不良心脏事件的发生风险,但作用尚不明确。有研究提出,症状和(或)无创性检查显示,存在冠心病的患者在非心脏手术术前可能需要行有创性冠状动脉造影,必要时行血运重建。新近指南建议急性冠状动脉综合征行非心脏手术患者术前应常规进行冠状动脉造影或血运重建,而慢性冠状动脉综合征患者则仅对高风险人群[优化药物治疗效果不佳和(或)高风险病变]行冠状动脉造影或血运重建,非高风险病变患者的优化处理方案尚不明确。

For medium/high-risk coronary heart disease patients undergoing non-cardiac surgery,the aims of routine preoperative coronary angiography and revascularization are improving risk stratification and reducing the risk of perioperative adverse cardiac events,though the effects remain not yet clear.Some studies suggest that the patients with symptoms and/or non-invasive examination showing the presence of coronary heart disease may require invasive coronary angiography before non-cardiac surgery,and if necessary,revascularization.Recent guidelines indicate that routine coronary angiography or revascularization before surgery is required routinely for the patients with acute coronary syndrome undergoing non-cardiac surgery,while for those with chronic coronary syndrome,the angiography or revascularization is only for high-risk populations(with poor drug treatment and/or high-risk lesions),and the optimal treatment plan for non-high-risk lesions is not clear yet.