Cardiac Risk Stratification Among Ambulatory Patients Undergoing Non-Cardiac Surgery

Cardiovascular complications are the leading cause of death within 30 days after non-cardiac surgery. Accurate perioperative cardiac risk assessment can be difficult and involves use of clinical risk indices; non-invasive cardiac testing, and potential cardiac biomarker levels are on the horizon. The association of presence and or severity of perfusion defects on non-invasive cardiac testing to adverse postoperative cardiac outcome needs better than observational evidence. Guidelines supporting judicious and meaningful use of preoperative non-invasive cardiac testing exist, but these are not based on randomized controlled data. There is also a relative paucity of prospective randomized controlled data assessing the role of preoperative coronary revascularization, except for patients with three vessels or left main disease. On the other hand, recent randomized controlled trials suggest higher postoperative mortality among patients with asymptomatic elevation of cardiac troponins in the perioperative period that do not qualify as myocardial infarction. © 2016, Springer Science + Business Media New York.