Cardiovascular Medicine Book

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ACC-AHA Preoperative Cardiac Risk Assessment

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  1. See Also
    1. ACP Preoperative Cardiac Risk Assessment
    2. Preoperative Cardiovascular Evaluation
    3. Eagle's Cardiac Risk Assessment
  2. Protocol
    1. Step 1: Evaluate urgency of noncardiac surgery
      1. Emergency requires surgery regardless of risk
      2. Manage Cardiac Risk Factors postoperatively
    2. Step 2: Noninvasive cardiac testing not required
      1. No acute cardiovascular disease and able to perform 4 METS without symptoms
      2. Coronary revascularization in past 5 years
        1. Must be stable and no recurrent symptoms or signs
      3. Coronary evaluation in last 2 years
        1. Evaluation must have been favorable and adequate
        2. No new symptoms or signs since evaluation
    3. Step 3: Indications for noninvasive cardiac testing
      1. Evaluation based on patient risk factors
        1. See Eagle's Cardiac Risk Assessment (typically used for ACC-AHA Guideline)
        2. See Detsky's Modified Cardiac Risk Index
        3. See Lee's Revised Cardiac Risk Index
      2. Consider in patients with functional capacity <4 METS or unknown capacity
      3. Major patient risk factors
        1. Indication: Three or more risk factors and cardiovascular surgery
        2. Cardiac evaluation needed in all cases
      4. Intermediate Risk: Indications for cardiac evaluation
        1. See High Risk Surgery
        2. Indication: Vascular Surgery or Intermediate Risk Surgery and at least 1 risk factor
      5. Minor risk: Indications for no cardiac evaluation
        1. Evaluate on individual basis
        2. No symptoms at functional capacity >4 METS activity requires no evaluation
  3. Reference
    1. (2007) ACC-AHA Guidelines
    2. Eagle (2002) Circulation 105:1257

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