Preoperative evaluation: angiography

Coronary angiography is a well-established, invasive, diagnostic procedure. Despite the fact that coronary artery disease may be present in a significant number of patients requiring non-cardiac surgery, indications for preoperative coronary angiography and revascularization are similar to angiography indications in the non-surgical setting and should rely predominantly on symptoms. Revascularization is usually reserved for patients with urgent or unstable conditions such as unstable angina, high-risk disease, or angina unresponsive to medical therapy. Coronary angiography can be performed non-invasively by computed tomography (CT). Coronary CT angiography may have advantages for risk stratification prior to non-cardiac surgery. Coronary CT can not only reliably exclude coronary artery disease but also detect high-risk coronary anatomy. Coronary CT angiography may be supplemented by functional testing using CT-derived fractional flow reserve, which allows identification of lesion-specific myocardial ischaemia in the same investigation.