Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery

More than 230 million surgical operations are performed yearly in the world and this number is continually growing. Thirty days mortality in moderate and high risk non-cardiac surgery is about 2% and exceeds 5% in patients with high cardiac risk. European Society of Cardiology (ESC) issued specific guidelines in 2009. ESC experts created clear stepwise algorithm for assessment of risk of cardiac complications in preoperative period and use of diagnostic and curative procedures aimed at its lowering. This allows to avoid unjustified investigations and drug therapy in operations with low cardiac risk and stresses significance of perioperative medical treatment. This review contains an analysis questioning some statements of the novel ESC guidelines such as reduction of preoperative cardiac tests and prophylactic revascularization of coronary arteries before operations with intermediate and high risk of cardiac complications.