Coronary Artery Disease (Left Main and Non–Left Main Disease)

Incidence in USA: 15.5 million.

Approximately 735,000 pts per y with CAD will have an acute MI and approximately 15% of these will die.

CAD is responsible for approximately 1 of every 7 deaths in USA.

Male predominance in pts <55 y old, but M = F in >55 y old.

Risk factors include Htn, diabetes, smoking, familial incidence, hyperlipidemia, and high cholesterol.

Presence of disease by coronary anatomy is a good predictor of survival with CAD.

Presence of left main disease with a high degree of stenosis is life threatening.

Recent MI increases risk, but revascularization interventions protect pt.

Impaired ventricular function, unstable anginal pattern, major surgery, and emergency surgery all increase risk.

Pts at increased risk if undergoing reoperation for bypass surgery.

Presence of a bare metal stent or drug eluting stent places pts at risk for a MI secondary to in-stent thrombosis (especially <1 mo after bare metal stent and <12 mo after drug eluting stent).

Myocardial ischemia, which can lead to MI

Postop MI, which carries very high mortality (>50%) in noncardiac surgical pts

Atherosclerosis in other vascular beds (CNS, renal, and mesentery)

Increased bleeding during and after surgery if pt is taking an anticoagulant for the prevention of MI

In-stent thrombosis with associated MI if pt discontinued antiplatelet medications (with up to 50% mortality)

Atherosclerosis of vessels supplying blood to the heart results in decreased blood flow by limitation of flow due to anatomy or vasoactive dysfunction (e.g., spasm)

Single greatest cause of death in USA population (approximately 370,000 deaths/y)

Most prevalent form of CV disease; approximately 15.5 million pts in the USA population have CAD

Leading cause of death in major noncardiac surgery