Le patient coronarien en chirurgie non cardiaque : quand envisager des explorations fonctionnelles ?

Noninvasive stress testing before noncardiac surgery consist of evaluating a patient without coronary artery disease symptoms to detect silent coronary ischemia that may become patent during the perioperative period and may have adverse consequences in terms of morbidity and mortality. The need for stress testing in patients with or at risk of coronary artery disease depends on two essential parameters: the patient's individual risk (related to the type of surgery he/she must undergo) and the estimated functional capacity (metabolic equivalent, MET). The two most commonly used stress tests are dobutamine echocardiography and thallium-dipyridamole scintigraphy. It should be noted that the preferred indication of these tests is the necessity of performing high-risk surgery in a patient bearing or at risk of coronary disease in whom the functional reserve is either low (< 4 MET) or not evaluable. Furthermore, if there is no expectation of any change in management related to the performance of the functional tests, it would seem wise to refrain from carrying them out.