About cardiovascular risk in non-cardiac surgery

The perioperative management of patients at risk for cardiovascular diseases who undergo non-cardiac surgery has been subject of debate over the past few decades and is still of great interest. An adequate perioperative management may modify postoperative mortality and morbidity and may improve the long-term prognosis. The purpose of this review is to examine the present day knowledge regarding the preoperative evaluation and perioperative and postoperative management. In spite of the available guidelines (the American College of Cardiology and the American Heart Association of 1996) and of several studies on this subject, many controversies still persist. The main questions are: 1) the preoperative cardiovascular evaluation through non-invasive tests (and the true predictive value of the increased cardiovascular risk) and 2) the real benefit of coronary revascularization before non-cardiac surgery. The last part of this review highlights many recent clinical observations and experimental studies regarding the efficacy of the extensive use of beta-adrenergic receptor blockers and optimized anti-ischemic pharmacological therapy in reducing the cardiovascular risk of non-cardiac surgery and in improving the long-term prognosis.