Cardiovascular medicine update 2007: Perioperative risk, carotid angioplasty, drug-eluting stents, stronger statins
Michael S. Lauer, MD
Departments of Cardiovascular Medicine and Quantitative Health Sciences, Cleveland Clinic; Professor of Medicine, Epidemiology, and Biostatistics, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; Contributing Editor, JAMA
Address: Michael S. Lauer, MD, Departments of Cardiovascular Medicine and Quantitative Health Sciences, JJ40, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail: firstname.lastname@example.org
Medical Grand Rounds articles are based on edited transcripts from Division of Medicine Grand Rounds presentations at Cleveland Clinic. They are approved by the author but are not peer-reviewed.
ABSTRACTSome recent clinical trials have concluded the following:
- Patients who need noncardiac surgery and who are at risk of major cardiac events should not undergo revascularization with the aim of achieving a better perioperative outcome. They should have an office evaluation only and be prescribed a beta-blocker, if indicated.
- Except for unusual, high-risk cases, patients at risk of stroke due to atherosclerotic carotid artery stenosis should undergo carotid endarterectomy rather than carotid stenting. Because the technology is still developing, however, carotid stenting may still be appropriate as part of a clinical trial.
- Although drug-eluting coronary stents reduce the risk of restenosis in the short term, they pose a small but significant risk of in-stent thrombosis. Clopidogrel (Plavix) should be prescribed for at least a year following drug-eluting stent placement, and perhaps indefinitely.
- Patients with known coronary heart disease have better outcomes if they receive aggressive statin therapy (eg, atorvastatin [Lipitor] 80 mg/day) to lower their serum levels of low-density lipoprotein cholesterol to less than 70 mg/dL.