22. For patients with stable coronary artery disease who undergo noncardiac surgery, we recommend against preoperative prophylactic coronary revascularization (Strong Recommendation; Low-Quality Evidence).

In the absence of clearly demonstrated benefit, the potential for surgical delays, increase in costs, and risk of bleeding with dual antiplatelet therapy supported a strong recommendation against prophylactic preoperative coronary revascularization.

In patients with CCS class III-IV or unstable angina, obtaining coronary revascularization before noncardiac surgery seems prudent; however, an individual risk-benefit assessment is required in patients who require urgent/semiurgent noncardiac surgery. Patients who receive PCI and a coronary stent should ideally have their noncardiac surgery delayed until the risks of stopping dual antiplatelet therapy are outweighed by the risks associated with delaying noncardiac surgery.