[Cardiologic assessment in candidates for non-cardiac surgery]

Cardiovascular complications are important causes of morbidity and mortality with major non cardiac procedures. The aim of preoperative cardiac evaluation is more appropriately the initiation of a process of communication between Cardiologist, Surgeon and Anesthesiologist, with the purpose of performing an evaluation of patient's clinical risk profile and of providing the more cost-effective strategy to reduce risk of cardiac complications. There is general agreement that an accurate clinical evaluation is necessary and often sufficient for preoperative cardiac risk assessment. Several indices for prediction of cardiac complications--based on the history and physical examination of the patient--have been proposed and many of them have been validated by following studies. An effective preoperative evaluation must focus four crucial data: clinical predictors and functional capacity of the patient and, on the other side, the specific risk of the type of surgical operation and its character of election or emergency. According to the integrated valuation of these four parameters we can identify the patients who need additional noninvasive testing from those who can directly undergo noncardiac surgery. Preoperative testing should be limited to circumstances in which the results will affect patient management and outcomes. Coronary angiography and following revascularization have the same indications as if performed in the non-operative setting.