Should recent clinical trials change perioperative management in patients with cardiac risk factors?

Abstract

A 75-year-old man with a known history of an ischemic cardiomyopathy presents for resection of a presumed malignant liver tumor. He had 2 cardiac stents placed in the last year and a half. His medications include spironolactone, lisinopril, pioglitazone, and atorvastatin. He also takes 81 mg aspirin per day. A recent cardiac catheterization showed that his stents were wide open and there was evidence of diffuse, cardiac arterial disease not amenable to stenting or surgery. His ejection fraction is 32 %, and there is diastolic dysfunction on his echocardiogram.