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)

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Revised Table 1. Clinical Predictors of Increased Perioperative Cardiovascular Risk (Myocardial Infarction, Congestive Heart Failure, Death)

• Acute or Rrecent MI* with evidence of important ischemic risk by clinical symptoms or noninvasive study
• Unstable or severe† angina (Canadian Class III or IV)‡

Decompensated congestive heart failure
Significant arrhythmias

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

Severe valvular disease

Intermediate
Mild angina pectoris (Canadian Class I or II)
Previous MI by history or pathological Q waves
Compensated or prior congestive heart failure
Diabetes mellitus (particularly insulin-dependent)
Renal insufficiency

Minor
Advanced age
Abnormal ECG (left ventricular hypertrophy, left bundle-branch block, ST-T abnormalities)
Rhythm other than sinus (eg, atrial fibrillation)
Low functional capacity (eg, inability to climb one flight of stairs with a bag of groceries)
History of stroke
Uncontrolled systemic hypertension

ECG indicates electrocardiogram; MI, myocardial infarction.
*The American College of Cardiology National Database Library defines recent MI as greater than 7 days but less than or equal to 1 month (30 days); acute MI is within 7 days.
†May include "stable" angina in patients who are unusually sedentary.
‡Campeau L. Grading of angina pectoris. Circulation. 1976;54:522-523.