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Editorials

We Were Fishing for TROUT and We Caught a CARP

Musings on Perioperative Management in an Age of Enlightenment

Kim A. Eagle, MD and Hitinder S. Gurm, MD

From the University of Michigan Cardiovascular Center, Ann Arbor, Mich.

Correspondence to Kim A. Eagle, MD, University of Michigan Cardiovascular Center, 1500 East Medical Center Drive, Suite 2131, Ann Arbor, MI 48109-5852. E-mail keagle@umich.edu

Key Words: cardiovascular diseases • heart diseases • risk factors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Have you ever gone fly-fishing for trout and all you caught were carp? It is a frustrating experience to be sure. Often, the river or lake looked like "fish country" and the conditions and approach made sense, but usually the problem was simple. You were fishing in the wrong place!

Article see p 73

This simple metaphor reminds us of the journey we have experienced during the past 25 years with evaluating and treating coronary artery disease in patients undergoing noncardiac surgery. We began the journey by clearly enunciating that heart attacks were a major cause of important and sometimes fatal postoperative outcomes.^1,2 We derived a number of epidemiological and Bayesian methods for identifying patients most likely to harbor underlying coronary artery disease.^3,4 We then identified and confirmed that a number of noninvasive techniques could be used to further stratify coronary risk in several clinical risk cohorts, potentially allowing a rational approach to screening patients into low-, moderate-, and high-risk subsets.^5,6 The water looked right, our approach looked right, so we fished. It made eminent sense that by revascularizing blocked or narrowed coronary arteries, we could reduce the risk of postoperative heart attacks and coronary death. "We were fishing for TROUT (Treatment to Reduce Outcomes in Noncardiac Surgery) but we caught a CARP (Coronary Artery Revascularization Project)! We were fishing in the wrong place."

In this issue of Circulation: Cardiovascular Quality and Outcomes, Garcia et al⁷ provide us with an important secondary analysis of the data from the CARP . . . [Full Text of this Article]

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Circ Cardiovasc Qual Outcomes 2009 2: 73-77. [Abstract] [Full Text] [PDF]

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