OBJECTIVE: Whether coronary revascularization - percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) before non-cardiac surgery reduces the cardiac risk is controversy. METHODS – We collected and analyzed the clinical and angiographic data of patients who were referred for coronary angiography (CAG) before non-cardiac surgery from Mars 1998 to July 2006 in Seoul National University Hospital. We compared the rates of in-hospital mortality, myocardial infarction (MI), stroke and arrthymia during post-operative periods and adverse cardiovascular outcomes (cardiac death,MI and stroke) during 1 year follow-up period. RESULTS - A total of 239 patients were referred for preoperative CAG due to high risk surgery, positive non-invasive stress test or recent MI etc. CAG showed significant coronary artery stenosis in 142 patients (59%) and 65 patients (27%) were recommended to undergo preoperative revascularization and 15 pts did not undergone non-cardiac surgery due to patient`s refusal or medical consideration on poor prognosis. So, 49 (21%) pts of 127 pts with significant stenosis on CAG, had undergone revascularization [(CABG for 20 pts (8.4%) vs. PCI for 29 pts (12 %)]. In PCI group, Bare metal stent (BMS) was used for 12 pts and drug eluting stent (DES) for 15 pts and POBA only was performed to 2 pts. Surgery were delayed for 131[41-315] days for DES, 34 [0-135] days for BMS and 12[9-16] days for POBA. During perioperative period, one pt (1.3%) was expired in medical therapy group and in PCI group, one pt (3.8 %) was expired after surgery and in CABG group, one pt (5 %) was expired during CABG. For morbidity, there were 2 pts (6.7 % :stroke) in PCI group and 2 pts (10 %: stroke) in CABG group.The adverse cardiac event within 1 year was 1.8 % (cardiac death : 1 pt) in medical therapy group, 3 pts [1 pt (3.4 %): cardiac death and 2 pts(6.8 %:stroke)] in PCI group and one pt (5 % : stroke)in CABG group]. CONCLUSIONS – This result suggest that judicious selection of patients for intensive medical treatment appears safe and is associated with low rate of cardiac events after non-caonrdiac surgery.