Coronary Artery Disease 

 

 

Considerations

 

  • ↑ risk of perioperative cardiovascular complications: MI, CHF, arrhythmias, death

  • ↓ cardiovascular reserve & need to optimize myocardial oxygen supply & demand

  • Comorbidities: HTN, stroke, renal dysfunction, peripheral vascular disease, diabetes, smoking 

  • Management of coronary stents 

  • Associated medications: antihypertensives, anticoagulants, diuretics 

 

 

Goals

 

  • Optimize myocardial oxygen supply & demand 

  • Preload: keep the heart small to ↓ wall tension/LVEDP & ↑ coronary perfusion pressure gradient 

  • Rate & rhythm: slow, normal sinus rhythm

  • Contractility: maintain

  • Afterload: maintain, coronary perfusion dependent on diastolic pressure 

 

 

Potential conflicts

 

  • Full stomach vs need for titrated induction

  • Need for surgery vs antiplatelets for coronary stents

 

 

Minimum antiplatelet therapy duration

 

  • Balloon angioplasty: 2 weeks

  • Bare metal stent: 1 month

  • Drug eluting stent: 1 year (but could be less; guidelines are evolving)