The AHA Guidelines and Scientifi c Statements Handbook
cardiomyopathy is not well-established. (Level
of Evidence: C)
Class III
Routine perioperative evaluation of LV function in
patients is not recommended. (Level of Evidence: B)
Recommendations for preoperative resting
12-lead ECG
Class I
1 Preoperative resting 12-lead ECG is recom-
mended for patients with at least one clinical risk
factor* who are undergoing vascular surgical proce-
dures. (Level of Evidence: B)
2 Preoperative resting 12-lead ECG is recom-
mended for patients with known coronary heart
disease, peripheral arterial disease, or cerebrovascu-
lar disease who are undergoing intermediate-risk
surgical procedures. (Level of Evidence: C)
Class IIa
Preoperative resting 12-lead ECG is reasonable in
persons with no clinical risk factors who are under-
going vascular surgical procedures. (Level of Evi-
dence: B)
Class IIb
Preoperative resting 12-lead ECG may be reasonable
in patients with at least 1 clinical risk factor who are
undergoing intermediate-risk operative procedures.
(Level of Evidence: B)
Class III
Preoperative and postoperative resting 12-lead
ECGs are not indicated in asymptomatic persons
undergoing low-risk surgical procedures. (Level of
Evidence: B)
Recommendations for noninvasive stress testing
before noncardiac surgery [9]
Class I
Patients with active cardiac conditions (Table 8.1)
in whom noncardiac surgery is planned should be
evaluated and treated per ACC/AHA guidelines†
before noncardiac surgery. (Level of Evidence: B)Class IIa
Noninvasive stress testing of patients with three or
more clinical risk factors and poor functional capac-
ity (less than four metabolic equivalents [METs])
who require vascular surgery‡ is reasonable if it will
change management. (Level of Evidence: B)Class IIb
Noninvasive stress testing may be considered for
patients with at least one to two clinical risk factors
and poor functional capacity (less than 4 METs)
who require intermediate-risk noncardiac or vascu-
lar surgery if it will change management. (Level of
Evidence: B)Class III
1 Noninvasive testing is not useful for patients with
no clinical risk factors undergoing intermediate-risk
noncardiac surgery. (Level of Evidence: C)
2 Noninvasive testing is not useful for patients
undergoing low-risk noncardiac surgery. (Level of
Evidence: C)Recommendations for preoperative coronary
revascularization with coronary artery bypass
grafting or percutaneous coronary intervention
[4–6,11–13]
See Figs 8.2 and 8.3.
(All of the Class I indications below are consistent
with the ACC/AHA 2004 Guideline Update for Cor-
onary Artery Bypass Graft Surgery [14].)- Clinical risk factors include history of ischemic heart disease,
history of compensated or prior heart failure, history of cere-
brovascular disease, diabetes mellitus, and renal insuffi ciency.
† ACC/AHA/ESC 2006 Guidelines for the Management of
Patients With Atrial Fibrillation (1), ACC/AHA 2005 Guide-
line Update for the Diagnosis and Management of Chronic
Heart Failure in the Adult (2), ACC/AHA Guidelines for the
Management of Patients With ST-Elevation Myocardial
Infarction (3), ACC/AHA/ESC Guidelines for the Manage-
ment of Patients With Supraventricular Arrhythmias (4),
ACC/AHA Guidelines for the Management of Patients With
Unstable Angina and Non-ST-Segment Elevation Myocardial
Infarction (5), ACC/AHA 2006 Guidelines for the Manage-
ment of Patients With Valvular Heart Disease (6), and ACC/
AHA/ESC 2006 Guidelines for the Management of Patients
With Ventricular Arrhythmias and the Prevention of Sudden
Cardiac Death (7).
‡ Vascular surgery is defi ned by aortic and other major vascu-
lar surgery and peripheral vascular surgery. See Table 8.3.