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.