Cardiovascular medicine update 2007: perioperative risk, carotid angioplasty, drug-eluting stents, stronger statins.

Full Abstract

Some 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.

Author information

Author/s: Lauer, Michael S (MS);

Affiliation: Departments of Cardiovascular Medicine and Quantitative Health Sciences, Cleveland Clinic, Cleveland Clinic Foundation, OH 44195, USA. lauerm(-atsign-)ccf.org

Journal and publication information

Publication Type: Journal Article; Review

Journal: Cleveland Clinic journal of medicine (Cleve Clin J Med), published in United States. (Language: eng)

Reference: 2007-Jul; vol 74 (issue 7) : pp 505-11

Dates: Created 2007/08/08; Completed 2007/10/15;

PMID: 17682627, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.