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Perioperative Cardiac Evaluation
Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery
American College of Cardiology / American Heart Association
JACC 1996; 27:910-948; and Circulation 1996; 93:1278-1317.
Pocket Guideline: requires Adobe Acrobat Reader

Need for cardiac surgery?


Proceed to the Operating Room.

Postoperative risk stratification and risk factor management.
Coronary revascularization within 5 years?


Recurrent symptoms or signs?


Recent coronary evaluation?


Recent coronary angiogram or stress test?


Proceed to Operating Room
Clinical Predictors:

Major Clinical Predictors:


l Recent MI (< 1 month ago) with evidence of important ischemic risk by clinical symptoms or noninvasive study
l Unstable or severe angina (Canadian Cardiovascular Society Class III or IV)



l High-grade atrioventricular block
l Symptomatic ventricular arrhythmias in the presence of underlying heart disease
l Supraventricular arrhythmias with uncontrolled ventricular rate



Intermediate Clinical Predictors:






Minor Clinical Predictors:









  • Consider delay or cancel noncardiac surgery
  • Medical management and risk factor modification
  • Consider coronary angiography
Subsequent care dictated by findings and treatment results
Subsequent care may include cancellation or delay of surgery, coronary revascularization followed by noncardiac surgery, or intensified care.

Intermediate Clinical Predictors

Functional Capacity:





Surgical Risk:






Results of Non-Invasive Testing:
Myocardial perfusion imaging or stress echocardiography


  • Consider coronary angiography.
  • Subsequent care dictated by findings and treatment results
Subsequent care may include cancellation or delay of surgery, coronary revascularization followed by noncardiac surgery, or intensified care.
Minor Clinical Predictors

Functional Capacity:



Minor Clinical Predictors

Surgical Risk:




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