Diagnosis
2
Figure 1. Stepwise Approach to Perioperative
Cardiac Assessment for CAD
Patient scheduled for surgery
with known or risk factors for
CAD (Step 1)
No further
testing
(Class III:NB)
Emergency
Clinical risk
stratification and
prceed to surgery
ACS
(Step 2)
Evaluate and
treat according to
GDMT
Low risk (<1%)
(Step 4)
Elevated risk
(Step 5)
Moderate
or greater (≥4
METs) funtional
capacity
Proceed to
surgery
Poor OR
unknown
functional capacity
(<4 METs):
Will further testing impact
decision making OR
perioperative care?
(Step 6)
No further
testing
(Class IIa)
Proceed to
surgery
Proceed to surgery according to
GDMT OR alternate strategies
(noninvasive treatment,
palliation) (Step 7)
Pharmacologic
stress testing
(Class IIa)
Coronary
revascularization
according to
existing CPGs
(Class I)
Estimated perioperative risk
of MACE based on combined
clinical/surgical risk
(Step 3)
Excellent
(>10 METs)
Moderate/
Good
(≥4-10 METs)
NO
No further
testing
(Class IIb)
if abnormal if normal
NO
or unknown
YES
NO
NO
YES
YES
