Coronary Artery Disease
Considerations
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↑ risk of perioperative cardiovascular complications: MI, CHF, arrhythmias, death
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↓ cardiovascular reserve & need to optimize myocardial oxygen supply & demand
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Comorbidities: HTN, stroke, renal dysfunction, peripheral vascular disease, diabetes, smoking
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Management of coronary stents
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Associated medications: antihypertensives, anticoagulants, diuretics
Goals
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Optimize myocardial oxygen supply & demand
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Preload: keep the heart small to ↓ wall tension/LVEDP & ↑ coronary perfusion pressure gradient
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Rate & rhythm: slow, normal sinus rhythm
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Contractility: maintain
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Afterload: maintain, coronary perfusion dependent on diastolic pressure
Potential conflicts
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Full stomach vs need for titrated induction
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Need for surgery vs antiplatelets for coronary stents
Minimum antiplatelet therapy duration
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Balloon angioplasty: 2 weeks
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Bare metal stent: 1 month
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Drug eluting stent: 1 year (but could be less; guidelines are evolving)