American College of Cardiology

EAGLE ET AL., PERIOPERATIVE CARDIOVASCULAR EVALUATION FOR NONCARDIAC SURGERY UPDATE
http://www.acc.org/clinical/guidelines/perio/update/periupdate_index.htm

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

XI. Conclusions

Successful perioperative evaluation and management of high-risk cardiac patients undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, the patient's primary care physician, and the consultant. In general, indications for further cardiac testing and treatments are the same as in the nonoperative setting, but their timing is dependent on several factors, including the urgency of noncardiac surgery, patient-specific risk factors, and surgery-specific considerations. The use of both noninvasive and invasive preoperative testing should be limited to those circumstances in which the results of such tests will clearly affect patient management. Finally, for many patients, noncardiac surgery represents their first opportunity to receive an appropriate assessment of both short- and long-term cardiac risk. Thus, the consultant best serves the patient by making recommendations aimed at lowering the immediate perioperative cardiac risk, as well as assessing the need for subsequent postoperative risk stratification and interventions directed to modify coronary risk factors. Future research should be directed at determining the value of routine prophylactic medical therapy vs. more extensive diagnostic testing and interventions.