II. Background

  1. Replaced by ACC-AHA Preoperative Cardiac Risk Assessment
  2. Listed for historical reasons only

III. Criteria: Eagle and Vanzetto

  1. Age over 70 years
  2. Diabetes Mellitus
  3. Q waves on ECG
  4. History of Angina Pectoris
  5. History of Myocardial Infarction
  6. History of ventricular ectopy
  7. History of Congestive Heart Failure
  8. ST segment abnormalities on EKG
  9. Hypertension with Left Ventricular Hypertrophy

IV. Protocol

  1. Indications for surgery without further evaluation
    1. Young healthy patient undergoing minor surgery
    2. Noncardiac emergency surgery
  2. Detsky's Modified Cardiac Risk Index
    1. Class I Risk Index
      1. Eagle and Vanzetto criteria: 0 to 1 (see above)
        1. Considered low risk of cardiac event (3%)
        2. Proceed to surgery without further evaluation
      2. Eagle and Vanzetto criteria: 2 or more (see above)
        1. Intermediate risk of cardiac event (3 to 15%)
        2. Proceed to surgery without further evaluation
        3. Nonvascular surgery proceeds without evaluation
        4. Vascular surgery evaluation with Stress Imaging
          1. Negative test: Surgery may proceed
          2. Positive test: Manage as high risk below
    2. Class II or Class III Risk Index
      1. Considered high risk of cardiac event (>15%)
      2. Consider revascularization for CAD
      3. Manage CHF, arrhythmia, valve disease
      4. Minimize Cardiac Risk

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