PIG Meeting: 18th February 2021

73 year old man for unicompartmental knee replacement

Background

• IHD with significant history of ACS requiring PCI between 2000 and 2008.
• No symptoms reported in last 12 years.
• NIDDM. HBA1c = 7.2
• DASI 7 METS. Can mow lawn slowly.
• BMI = 39

Issues

• MIBI ordered in clinic – moderately impaired coronary perfusion reserve in a single coronary artery territory (RCA). Reduction in LVEF post-stress. Findings stratify the patient to be intermediate-high risk for perioperative coronary events during high risk surgical procedures
• Dr Nick Collins reviewed and recommends deferment of procedure and coronary angiogram

Discussion

• Suitability of testing given asymptomatic with reasonable functional capacity
• AHA guidelines would suggest no requirement for non-invasive stress testing with DASI of 7 METS
• Consensus that if patient had attended regular cardiology follow-up, he would have likely had a stress test in the preceding 12 years given diabetic patient with known coronary artery disease.

Plan

• Defer surgery pending coronary angiogram +/- PCI