A systematic clinical assessment is needed to determine cardiac risk in patients undergoing noncardiac surgery, rather than routine angiography or noninvasive testing.
Supports clinical assessment over routine testing for perioperative cardiac risk; leaves open optimal strategies pending prospective trials.
The cardiac risk associated with noncardiac surgery is due primarily to clinically silent or apparently stable coronary artery disease that is unmasked by the stress of surgery. Since it is too hazardous and expensive to perform coronary angiography on all preoperative patients, a systematic approach that relies on a simple clinical assessment is needed to determine the surgical risk. It is also too expensive to perform noninvasive laboratory tests in all patients. The best approach takes into consideration the type of surgery, the clinical likelihood of an event, the relative usefulness of the laboratory tests, and the therapeutic options for . . .
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Eagle et al. (1989) studied this question.
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