PIG Meeting: 8th April 2021
Referral letter from a general surgeon requesting an urgent perioperative consult for a 63-year-old man with ascending colon cancer.
Daily angina and history of PCI sometime in the last 10 years
- PCI for coronary artery disease in last 10 years
- No regular cardiology follow-up
- No anti-platelet therapy and never been on DAPT
- Daily exertional angina after walking 20-30 metres and after meals
- Morbid obesity
- Urgent surgery
- Consult letter is concerning that patient is high risk and not optimally managed
- More information is required in order quantify perioperative risk
- Patient should be referred for stress imaging
- Discussion around different modalities of stress imaging. Little evidence to suggest superiority, both nuclear imaging and stress echo have high NPV for post op cardiac events.
- Stress echo investigation of choice by cardiologists but not easy to obtain in our district, especially in an urgent setting
- CTCA discussed, non-invasive test, better predictive value in younger people with decreased calcium load
- CTA vision study showed that CTCA over-estimated risk of MACE compared with RCRI. (paper attached)
- Discussion around benefits vs risks of PCI in the setting of urgent surgery.
- May not be possible to delay surgery for 3- 6 months if coronary intervention required
- Newer DES require shorter duration of DAPT
- Need to consider that PCI may not confer a clinical benefit unless a LAD lesion with large areas of myocardium affected
- Urgent perioperative consult
- Sestamibi and resting echocardiogram
- Referral to rapid access cardiology clinic already underway from surgical team
- Can also be discussed at weekly cardiology meeting