Patients undergoing noncardiac vascular surgery are at significant risk of perioperative cardiac complications.1,2 Though recent developments in anesthesiologic and surgical techniques, eg, loco-regional anesthesia and endovascular treatment modalities, have improved postoperative cardiac outcome considerably, perioperative cardiac complications remain a significant problem. Myocardial infarction (MI) accounts for 10 to 40 of perioperative fatalities, and is considered to be the major determinant of postoperative mortality in noncardiac vascular surgery.3-5 This increased risk of perioperative cardiac complications is a function of both the patient population at risk and the surgical procedure. Importantly, noncardiac vascular surgery patients frequently have underlying symptomatic or asymptomatic coronary artery disease (CAD). A landmark study by Hertzer et al showed that 61 of 1000 patients undergoing noncardiac vascular surgery had at least one significant coronary artery stenosis (>=50).
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