Colon cancer and angina

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
  • IDDM
  • 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