American College of Cardiology
Preoperative Assessment Guidelines


Dec 2001: Updated May 2006
for Full Text Article (pdf), click here

Clinical Predictors of Increased Perioperative Cardiovascular Risk
Major
    Unstable coronary syndromes
    Decompensated CHF
    Significant Arrhythmias
Intermediate
    Mild angina pectoris
    Prior MI
    Compensated or prior CHF
    Diabetes Mellitus
Minor 
    Advanced Age
    Abnormal ECG
    Rhythm other than sinus
    Low functional capacity
    History of stroke
    Uncontrolled HTN

Disease Specific Approaches
    Coronary Artery Disease (CAD)
    Patients with known CAD
    Patients with major risk factors for CAD
    Hypertension
    Congestive Heart Failure
    Valvular Heart Disease
    Arrhythmias and Conduction Defects
    Pulmonary Vascular Disease


Type of Surgery
Urgency
High surgical risk:
    Aortic and other major vascular
    Peripheral vascular
    Anticipated prolonged surgical procedures associated with large fluid shifts and/or blood loss

Intermediate surgical risk:
    Carotid endarterectomy
    Intraperitoneal and intrathoracic, orthopedic and prostate surgery

Low surgical risk:
    Endoscopic and superficial procedures
    Cataract surgery
    Breast surgery

Supplemental Preoperative Evaluation
    Noninvasive resting left ventricular function:
    Risk of complications greatest with EF<35%

Assessing Risk 
for Coronary Artery Disease & Functional Capacity

Goals: 
    -Provide objective measure of functional capacity
    -Identify presence of preoperative myocardial ischemia or cardiac arrhythmias
    -Estimate perioperative cardiac risk and long-term prognosis

Specific Approaches:
    -Exercise stress testing
    -Nonexercise stress testing:
        -Dobutamine stress echocardiography
        -Dipyridamole/adenosine thallium testing
    -Ambulatory electrocardiographic monitoring

Recommendations: 
Test of choice is Exercise ECG Testing
    -Provides estimate of functional capacity 
    -Detects myocardial ischemia