预先的PCI的优势 河北会.ppt

Patients with coronary artery disease (CAD) are at high riskof postoperative myocardial complications Preoperative coronary angiography in peripheral vascular surgical candidates has already shown the high prevalence of CAD in this population Theoretically support the performance of coronary angiography, and possibly stenting, as part of the standard preoperative protocol for patients scheduled to undergo peripheral arterial revasculavisation   The benefit of preop-coronary angiography or stenting of coronary before peripheral revascularvisation remains disparate opinions Some studies have shown the safety and efficacy of coronary angiography and revascularivsation in preventing postoperative cardiac events in non-cardiac surgery Some reports have failed to demonstrate the bene?t of such an aggressive preoperative protocol, with the risk of operative bleeding due to the aspirin and clopidogrel regimen, which is required when performing coronary stenting In our study, we devided all patients into 2 groups depending on patients’s ECG (the significant changes and mild abnormal changes of ECG ), all patients without any clinical history , scheduled to undergo an elective carotid endarterectomy (CEA). In group A(the significant changes of ECG ), all patients had coronary angiography, followed, if needed, by coronary angioplasty with stenting In group B(mild abnormal changes of ECG )，Patients randomized to received a standard cardiac evaluation before endarterectomy Patients referred for CEA were eligible for enrollment if they had no apparent evidence of CAD, defined as the absence of any clinical sign or history of ischaemic cardiac disease, and with a left ventricular ejection fraction 50% at trans-thoracic echocardiogram After determination of eligibility for the trial, including a standard preoperative cardiac evaluation, patients were assigned either to undergo CEA (group B) or to complete this evaluation with coronary angiography followed, if neede