ACC, AHA post new guidelines for noncardiac surgery

Heart disease patients should take precautions before undergoing any surgery, even noncardiac surgery, to reduce the risk of a cardiac event, according to new guidelines from the American College of Cardiology and the American Heart Association.

The guidelines, which update those published in 2002, provide a framework to consider a person’s risk of a cardiac event in the perioperative period of noncardiac surgery.

According to the joint recommendations, patients should not stop taking cholesterol-lowering drugs before surgery. The guidelines now say heart disease patients can safely undergo noncardiac surgery without first rectifying their heart disease with an artery-opening procedure or coronary bypass grafting. Also, the guidelines address patients who need a heart procedure before noncardiac surgery, who should have coronary stents or may need anti-clotting medication.

"In the past we had to go on indefinite evidence, but now there are a number of studies published to help us direct best practices,” said Lee A. Fleisher, MD, chair of the guideline writing committee and chair of the department of anesthesiology and critical care at the University of Pennsylvania School of Medicine.

The guidelines also recommend coronary artery bypass grafting or angioplasty before a noncardiac surgery for heart disease patients, such as those who have two or more blocked blood vessels, unstable angina or heart attack symptoms.

The complete guidelines will be published in the Oct. 23 issue of Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.