Pre-operative cardiac evaluation before non-cardiac surgery

Several recent guidelines have been published to codify the pre-operative evaluation of the cardiac patient undergoing non-cardiac surgery. Considering the lack of any randomized clinical trials in this area, they have incorporated information from both prospective cohort studies and the experience from the general care of the cardiac patient. The decision to perform testing is based on the clinical risk factors, exercise tolerance and surgical procedure. Testing should not be performed unless the results will actually change practice. Among the interventions advocated to reduce peri-operative risk, the decision to perform coronary revascularization before non-cardiac surgery must include issues related to local rates of morbidity and mortality for each of the procedures and potential long-term benefits.