This chapter provides a summary of pre- and perioperative assessment and management of patients with pre-existing cardiovascular disease undergoing non-cardiac surgery. More detailed presentations can be found in the preceding chapters in this section. An individualized, stepwise cardiac risk assessment protocol, integrating clinical risk indices and specific test results with the estimated stress of the planned surgical procedure is presented. For each step, evidence-based recommendations on medical therapy and cardiac interventions as well as considerations on surgical and anaesthetic techniques are presented in order to optimize the patient’s perioperative condition.