Worldwide 200 million adults annually undergo major noncardiac surgery and 5 million of these patients will suffer a major vascular complication. Despite the magnitude of this problem our capacity to predict these events is limited. Although perioperative myocardial infarction (MI) is the most common major perioperative cardiac complication, little is known about its pathophysiology. Coronary computed tomography angiography (CTA) is a potential non-invasive method for the detection of coronary artery disease and cardiac risk stratification in the non-operative setting; however, the value of this test to enhance risk prediction among patients scheduled for noncardiac surgery is unknown. This study is an international prospective cohort study to determine among patients with, or at risk of, atherosclerotic disease who are undergoing noncardiac surgery: 1) if preoperative coronary CTA has additional predictive value for the occurrence of major perioperative cardiac events and 2) the underlying coronary anatomy associated with perioperative MIs.

Inclusion Criteria:

• age >=45 years

• undergoing non cardiac surgery requiring an overnight stay and general or regional anaesthetic

• at least one of:

  1. Coronary Artery Disease (CAD)
  2. Peripheral Vascular Disease (PVD)
  3. History of Stroke
  4. History of Congestive Heart Failure (CHF)
  5. Combination of at least 3 of:

• age >= 70 years

• history of treatment for hypertension

• history of treatment for dyslipidemia

• smoking in last 2 years

• diabetic and currently taking insulin or oral diabetic drugs

• history of Transient Ischemic Attack (TIA)

Exclusion Criteria:

• contraindications to CTA

International non cardiac surgical patients