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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)
This
is a Guideline Update of the 1996 Perioperative Guidelines.
To highlight the changes, deleted text is indicated
by strikeout, and revised text is presented in red.
A clean version of the document, with changes fully
incorporated, is available for download and print.
Figures
Figure
1. Stepwise
approach to preoperative cardiac assessment. Steps are
discussed in text. *Subsequent care may include cancellation
or delay of surgery, coronary revascularization followed
by noncardiac surgery, or intensified care.
Figure
2.
Prediction
of long-term survival after major vascular surgery.
CAD indicates
coronary artery disease; LVEF
left ventricular ejection fraction.
Figure
3. Supplemental Preoperative
Evaluation: When and Which Test. Testing is only indicated
if the results will impact care.
Tables
Revised
Table 1. Clinical
Predictors of Increased Perioperative Cardiovascular
Risk (Myocardial Infarction, Congestive Heart
Failure, Death)
Table
2. Estimated
Energy Requirements for Various Activities*
Table
3. Cardiac Risk Stratification for Noncardiac
Surgical Procedures
Table
4. Indications for Coronary Angiography in
Perioperative Evaluation Before (or After) Noncardiac
Surgery Converted
to text during update.
Revised
Table 5. Prognostic
Gradient of Ischemic Responses During an ECG-Monitored
Exercise Test
New
Table 5a. Shortcut
to Noninvasive Testing in Preoperative Patients if Any
Two Factors Are Present
Table
6. Preoperative
Exercise Testing Before Major Noncardiac Surgery
Revised
Table 7. Myocardial
Perfusion
Dipyridamole-Thallium Imaging for Preoperative
Assessment of Cardiac Risk
Revised
Table 8. Summary
of Studies Examining the Value of Dobutamine Stress
Echocardiography for Preoperative Risk Assessment
Table
9. Predictive
Value of Preoperative ST-Segment Changes Detected by
Ambulatory Monitoring for Perioperative Myocardial Infarction
and Cardiac Death After Major Vascular Surgery
New
Table 9a. Studies
Reporting the Clinical Outcome of Patients Undergoing
Noncardiac Surgery After a Percutaneous Coronary Intervention
Revised
Table 10. Perioperative
Prophylactic Anti-Ischemic Medications and Cardiac Morbidity
Revised
Table 11. General
Guidelines for Perioperative Prophylaxis for Venous
Thromboembolism*
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