Key Points Ischemic Heart Diseases

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  1. The clinical predictors, the surgical procedure, and exercise capacity should be integrated in the decision-making process to avoid adverse perioperative cardiac events.
  2. Patients with active cardiac conditions (unstable or severe angina, recent MI) should be determined and treated before noncardiac elective surgery.
  3. The risk of the surgical procedure should also be considered. Patients for vascular surgery represent very high risk for perioperative ischemic events.

Patients with excellent exercise capacity, even in the presence of ischemic heart disease, will be able to tolerate the stresses of noncardiac surgery. The ability to climb two-to-three flights of stairs without significant symptoms (angina, dyspnea) is usually an indication of adequate cardiac reserve.

The type of acute revascularization should be carefully planned because patients with a drug-eluting stent should be on dual-antiplatelet therapy for at least a year.

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