The Preoperative Evaluation of the Patient With Cardiac Risk Factors for Noncardiac Surgery: Which Patients Need Further Cardiac Risk Stratification Tests?

Abstract

Cardiac risk stratification tests should be pursued only in the subgroup of patients who have a moderate to high incidence of significant coronary artery disease and only in those who will gain long-term benefit from coronary revascularization if they are found to have significant coronary artery disease. Furthermore, car diac risk stratification tests should be pursued only if the perioperative mortality and morbidity from com bined coronary revascularization followed by noncar diac surgery is not significantly higher than proceeding straight to noncardiac surgery alone. Indentification of the subgroup of patients who will need cardiac strati fication tests should be based on integration of the patient's cardiac risk factors and functional capacity with the risk and stress of the particular surgery.