[Management of coronary risk patients before anesthesia]

Noninvasive stress tests such as myocardial perfusion scintigraphy or dobutamine stress echography have to be performed, only if they modify the perioperative strategy. Prophylactic pre-operative coronary revascularization can be helpful only in selected cases, independently from the operative context. Coronary stenting in patients undergoing noncardiac surgery (bare metal stent or drug-eluting stents) adds an additional risk related to antiplatelet therapy management. Preoperative medical therapy optimisation is based on betablockers, and probably statins. Perioperative strategy in risk patients undergoing surgery is multimodal, it includes an adequate preoperative assessment, an optimisation of preoperative medical treatment, an optimisation of the per and post operative myocardial oxygen supply/requirement equilibrium. In case of low risk surgery, or in case of a patient with a good functional capacity, without symptoms, the operative assessment has to be minimal. For patients under antiplatelet therapy, a multidisciplinary discussion of optimal patient management strategy has to be notified in the patient file, this has to include the haemorrhagic and thrombosis discussion.