Abstract
Preoperative application of coronary angiography or percutaneous coronary intervention(PCI) is controversial in Japan. We report a case in which PCI, performed before minor surgery, led to acute myocardial infarction. An 83-year-old woman was scheduled for transurethral resection of a bladder tumor under spinal anesthesia. Her condition was complicated by type 1 diabetes mellitus, and she had a history of myocardial infarctions 21 years and 9 years previously. The ischemic symptoms had not exhibited since the last myocardial infarction under suitable medical treatment. Preoperative coronary angiography was performed, and revealed three-vessel disease. One month later, PCI was performed, but acute myocardial infarction occurred during the procedure, followed by cardiac collapse. The patient was resuscitated without neurological consequences, but was hospitalized for another 187 days. The planned surgery was canceled. This case lets us consider the adoption of ACC/ACH guidelines, in which PCI is not recommended before minor surgery on patients lacking major clinical predictors of increased cardiovascular risk. Otherwise, we have to establish another set of guidelines based on evidence applicable to the Japanese population.
