Revascularização miocárdica profilática versus otimização clínica pré-operatória em cirurgias não cardíacas: uma revisão integrativa da literatura

Abstract

Coronary artery disease represents a public health challenge and increases perioperative risk in patients undergoing noncardiac surgical procedures due to the physiological and hemodynamic stress imposed by trauma. Given this scenario, this study aims to analyze the inefficacy of prophylactic revascularization and consolidate the fundamental pillars of the clinical optimization strategy for these patients. This is an integrative literature review, developed through searches in the PubMed and SciELO electronic databases, which resulted in the final selection and inclusion of 21 studies for qualitative analysis. The synthesized results demonstrate that prophylactic invasive intervention does not confer protection against adverse outcomes in clinically stable patients, failing to prevent perioperative ischemia or mortality more effectively than conservative management. The primacy of the initial clinical assessment was evidenced, highlighting the importance of measuring functional capacity through metabolic equivalents and the use of validated scores, such as the revised cardiac risk index, to predict and mitigate cardiovascular complications. Furthermore, the literature consolidates the protective role of statins in stabilizing atherosclerotic plaques and indicates the contraindication of the acute use of high-dose beta-blockers in the immediate preoperative period due to associated morbidity and mortality risks. For individuals already carrying coronary stents, the literature states that strict observance of endothelialization periods before surgery is imperative to ensure the safe management of dual antiplatelet therapy, aiming to balance the risks of bleeding and device thrombosis. It is concluded, therefore, that perioperative cardiovascular management requires a paradigm shift, abandoning the purely anatomical and interventionist model in favor of continuous and multidisciplinary clinical optimization.