3
Table 2. Supplemental Preoperative Evaluation
Recommendations COR LOE
Multivariate Risk Indices
A validated risk-prediction tool can be useful in predicting the risk
of perioperative MACE in patients undergoing noncardiac surgery.
IIa B
For patients with a low risk of perioperative MACE, further
testing is NOT recommended before the planned operation.
III: No
Benefit
B
e 12-lead ECG
Preoperative resting 12-lead ECG is reasonable for patients
with known coronary heart disease, significant arrhythmia,
peripheral arterial disease, cerebrovascular disease, or other
significant structural heart disease, except for those undergoing
low-risk surgery.
IIa B
Preoperative resting 12-lead ECG may be considered for
asymptomatic patients without known coronary heart disease,
except for those undergoing low-risk surgery.
IIb B
Routine preoperative resting 12-lead ECG is NOT useful for
asymptomatic patients without known coronary heart disease,
except for those undergoing low-risk surgery.
III: No
Benefit
B
Assessment of LV function
It is reasonable for patients with dyspnea of unknown origin to
undergo preoperative evaluation of LV function.
IIa C
It is reasonable for patients with HF with worsening dyspnea or
other change in clinical status to undergo preoperative evaluation
of LV function.
IIa C
Reassessment of LV function in clinically stable patients with
previously documented LV dysfunction may be considered if there
has been no assessment within a year.
IIb C
Routine preoperative evaluation of LV function is NOT
recommended.
III: No
Benefit
B
Exercise stress testing for myocardial ischemia and functional capacity
For patients with elevated risk and excellent (>10 METs)
functional capacity, it is reasonable to forgo further exercise testing
with cardiac imaging and proceed to surgery.
IIa B
For patients with elevated risk and unknown functional capacity
it may be reasonable to perform exercise testing to assess for
functional capacity if it will change management.
IIb B
For patients with elevated risk and moderate to good (≥4 METs to
10 METs) functional capacity, it may be reasonable to forgo further
exercise testing with cardiac imaging and proceed to surgery.
IIb B
For patients with elevated risk and poor or unknown functional
capacity it may be reasonable to perform exercise testing with
cardiac imaging to assess for myocardial ischemia.
IIb C
Routine screening with noninvasive stress testing is NOT useful
for patients at low-risk for noncardiac surgery.
III: No
Benefit
B
