Preoperative cardiac risks in noncardiac surgery: The role of coronary angiography

The preoperative evaluation of patients candidates to noncardiac surgery requires a knowledge of factors related both to type of surgery and to features of the single patient, potentially responsible for perioperative cardiovascular complications, fatal and nonfatal. The assessment of symptoms and/or noninvasive testing indicating the presence of coronary artery disease may suggest the need for medical therapy optimization and, eventually, coronary arteriography before the scheduled timing of noncardiac surgery. There is no evidence favoring a prophylactic myocardial revascularization (percutaneous or surgical) and more studies are needed to define the role of coronary artery disease diagnosis and treatment before high-risk non cardiac surgery.