The American College of Cardiology (ACC) and American Heart Association (AHA) have issued a new guideline (last published in 2002) on the perioperative cardiovascular evaluation for patients considering noncardiac surgery. The new algorithm is simpler and gives clinicians more latitude in individualizing decisions, but does not apply to patients who require emergency surgery or who have active cardiac problems that require urgent intervention (such as unstable coronary syndromes, decompensated heart failure, arrhythmias, or valvular disease). Some highlights of the new guideline include the recommendations on non-invasive stress testing prior to noncardiac surgery which include:
Testing is not useful for patients undergoing low risk surgery, or for patients undergoing intermediate risk surgery with no clinical risk factors.
Testing can be considered for those with 1-2 risk factors with poor functional status undergoing intermediate risk surgery, or those with 1-2 risk factors and good functional status undergoing vascular surgery.
Testing is indicated for patients with 3 or more risk factors and poor functional status undergoing vascular surgery.
All non-invasive testing should be reserved for clinical situations where the testing is likely to change management decisions.
This extensive guideline also reviews the grade of evidence for the perioperative use of ECG, echocardiography, revascularization, beta blockers, alpha-2 agonists, statins, and other perioperative care (such as continuous ECG monitoring and blood sugar control).
Citation:
Fleisher LA, Beckman JA, Brown KA et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary. J Am Coll Cardiol. 2007;50(17):e159-241.
