Pre-operative assessment and management of the patient with ischaemic coronary artery disease in non-cardiac surgery.

Peri-operative cardiac events are the leading cause of death following anaesthesia and surgery. We attempt to put into perspective the various methods of pre-operative assessment of patients at risk, and suggest a logical sequence for the use of potentially costly investigations such as 12-lead ECG, exercise stress ECG, ambulatory ECG monitoring, myocardial perfusion imaging, radionuclide ejection fraction, and coronary angiography. Important principles are given for the management of patients at risk of peri-operative cardiac incidents if the decision is made to proceed with non-cardiac surgery despite the potential risk or because of inoperable coronary disease.