The purpose of this paper is to provide scientific and practical information on assessment of the risk of myocardical damage development after noncardiac operations (NOMD): ischemia or myocardial infarction (MI), and/or heart failure (HF) and their prevention in adult patients. This overview of literature consists of two parts. The first part analyzes epidemiology, etiopathogeneis, and POCC risk prediction methods; the second part describes the possibilities of adjuvant pharmacological cardioprotection and approaches to optimizing anesthesiological support of operative interventions in high cardiac risk patients.The problem of perioperative cardiac complications in noncardiac surgey is one of relevant complex issues of contemporary medicine. In line with contemporary views, NOMD is now regarded as a separate variant of a pathological process in the heart muscle. According to extensive studies, about 40% of mortality of adult patients during non-cardial operative inverventions are caused by various NOMD and/or HF. The problem under discussion is particularly relevant when medical assistance is rendered to elderly patients.

The second part of the overview presents and analyzes the current data on the methods of adjuvant pharmacological cardioprotection and possibilities of optimizing the anesthetic support and perioperative monitoring in high cardiac risk patients. Amendments made in international guidelines for the last 2–3 years on the basis of conclusive studies and meta-analyses have been examined. Cardioprotection mechanisms and information about its implementation in real clinical practice have been analysed. It has been shown that by no means all drugs under discussion can be widely used for prophytlactic purposes. Contemporary evidencebased recommendations concerning the optimization of anesthetic support and perioperative monitoring are given. A conclusion has been made that practical implementation of a comprehensive strategy aimed at reduction of the risk of cardiac complications might ensure decrease of both the incidence of severe cardiac complications and mortality due to them.