Coronary risk assessment in the management of patients undergoing noncardiac vascular surgery

Patients scheduled for noncardiac vascular surgery are at significant risk of cardiovascular morbidity and mortality due to underlying symptomatic or asymptomatic coronary artery disease. This review will give an overview of current preoperative cardiac risk assessment strategies for patients undergoing noncardiac vascular surgery. Clinical cardiac risk scores are useful tools for the simple identification of patients with an increased perioperative cardiac risk. These risk scores include factors as age, history of myocardial infarction, angina pectoris, congestive heart failure, cerebrovascular events, diabetes mellitus, and renal dysfunction. Based on these cardiac risk scores further cardiac testing might be warranted in patients at increased risk. Recent developments in laboratory tests, noninvasive cardiac imaging, cardiac stress testing, and invasive cardiac imaging in the preoperative work-up of vascular surgical patients are reviewed.