Cardiac Risk Assessment for Noncardiac Surgery

Goal: characterize risk of Pt & procedureappropriate testing (ie, results willmanagement) and interventions (ie, reasonable probability ofrisk of MACE)

Preoperative evaluation (NEJM 2015;373:2258)

Figure 1-7 Approach to preop CV eval for non-CV surgery
(modified from Circ 2014;130:e278)
Noninvasive Testing Result
High Risk Intermediate Risk Low Risk
Ischemia at < 4 METs manifested by ≥1 of:
  • Horiz/down ST ↓ ≥1 mm or STE
  • ≥5 abnl leads or ischemic ECG ∆s lasting >3 min after exertion
  • SBP ↓ 10 mmHg or typical angina
Ischemia at 4–6