Impact of non-cardiac surgery on the course of ischemic heart disease

The number of patients with cardiac disease undergoing non-cardiac surgery is increasing. Preoperative clinical risk stratification is based mainly on clinical evaluation. For patients with risk factors, pharmacologic therapy appears to be more effective than coronary revascularization. Adverse perioperative cardiac events, demonstrated by perioperative elevation of cardiac troponin 1 above the 99th percentile, predict postoperative and intermediate-term mortality. Beta-blockers decrease the risk of major perioperative cardiac events. Their benefits for intermediate and long-term cardiac morbidity remain to be demonstrated.