Perioperative care of the patient with cardiovascular disease undergoing non-cardiac surgery

The risk of perioperative cardiac events in cardiac patients undergoing non-cardiac surgery may be weighed against the benefits of proposed surgery using clinical risk factor analysis and different methods of assessing myocardial functional reserve. Stress testing modalities accurately delineate reversible myocardial ischaemia, but their positive predictive value is disputed, and it is unclear if their implementation improves outcome when compared to risk stratification alone. Similarly, it remains to be shown that preoperative coronary revascularization is an effective strategy in reducing perioperative risk. Recent reports indicate that surgery undertaken in the first weeks after percutaneous coronary interventions may be associated with a significantly increased rate of major complications. Administration of beta-blockers and alpha-2 adrenergic agonists to high-risk patients reduces surgical morbidity and mortality, and the benefits observed with beta-blockers extend long after surgery. Very close cooperation between cardiologists, anaesthetists and surgeons is necessary to minimize the risk of serious perioperative complications in urgent or emergency surgery.