Perioperative cardiovascular complications are important causes of
morbidity and mortality associated with non-cardiac surgery,
particularly in patients with coronary artery disease (CAD). Although
preoperative cardiac risk assessment can facilitate the identification
of vulnerable patients and implementation of adequate preventive
measures, excessive evaluation might lead to undue resource utilization
and surgical delay. Owing to conflicting data, there remains some
uncertainty regarding the most beneficial perioperative strategy for
patients with CAD. Antithrombotic agents are the cornerstone of
secondary prevention of ischaemic events but substantially increase the
risk of bleeding. Given that 5-25% of patients undergoing coronary stent
implantation require non-cardiac surgery within 2 years, surgery is the
most common reason for premature cessation of dual antiplatelet
therapy. Perioperative management of antiplatelet therapy, which
necessitates concomitant evaluation of the individual thrombotic and
bleeding risks related to both clinical and procedural factors, poses a
recurring dilemma in clinical practice. Current guidelines do not
provide detailed recommendations on this topic, and the optimal approach
in these patients is yet to be determined. This Review summarizes the
current data guiding preoperative risk stratification as well as
periprocedural management of patients with CAD undergoing non-cardiac
surgery, including those treated with stents.
