6
Treatment
Table 4. Perioperative Therapy
Recommendations COR LOE
Coronary revascularization before noncardiac surgery
Revascularization before noncardiac surgery is
recommended in circumstances in which revascularization
is indicated according to existing CPGs.
I C
It is NOT recommended that routine coronary
revascularization be performed before noncardiac surgery
exclusively to reduce perioperative cardiac events.
III: No
Benefit
B
Timing of elective noncardiac surgery in patients with previous PCI
Elective noncardiac surgery should be delayed 14 days aer
balloon angioplasty and 30 days aer BMS implantation.
I C: 14 days
aer balloon
angioplasty
B: 30 days
aer BMS
implantation
Elective noncardiac surgery should optimally be delayed
365 days aer DES implantation.
I B
In patients in whom noncardiac surgery is required, a
consensus decision among treating clinicians as to the relative
risks of discontinuation or continuation of antiplatelet
therapy can be useful.
IIa C
Elective noncardiac surgery aer DES implantation may
be considered aer 180 days if the risk of further delay
is greater than the expected risks of ischemia and stent
thrombosis.
IIb
a
B
Elective noncardiac surgery should NOT be performed
within 30 days aer BMS implantation or within 12
months aer DES implantation in patients in whom
dual antiplatelet therapy will need to be discontinued
perioperatively.
III: Harm B
Elective noncardiac surgery should NOT be performed
within 14 days of balloon angioplasty in patients in whom
aspirin will need to be discontinued perioperatively.
III: Harm C
Perioperative beta-blocker therapy
Beta blockers should be continued in patients undergoing
surgery who have been on beta blockers chronically.
I B
SR
b
It is reasonable for the management of beta blockers aer
surgery to be guided by clinical circumstances, independent
of when the agent was started.
IIa B
SR
b
In patients with intermediate- or high-risk myocardial
ischemia noted in preoperative risk stratification tests, it
may be reasonable to begin perioperative beta blockers.
IIb C
SR
b
a
Because of new evidence, this is a new recommendation since the publication of the 2011 PCI CPG.
b
ese recommendations have been designated with SR to emphasize the rigor of support from
the ERC's systematic review.
