Cardiac risk stratifi cation for noncardiac surgery. Update from the American College of Cardiology/American Heart Association 2007 guidelines

The American College of Cardiology and American Heart Association updated their joint guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery in 2007. The guidelines recommend preoperative cardiac testing only when the results may infl uence patient management. They specify four high-risk conditions for which evaluation and preoperative treatment are needed: unstable coronary syndromes, decompensated heart failure, signifi cant cardiac arrhythmias, and severe valvular disease. Patient-specifi c factors and the risk of the surgery itself are considerations in the need for an evaluation and the treatment strategy before noncardiac surgery. In most instances, coronary revascularization before noncardiac surgery has not been shown to reduce morbidity and mortality, except in patients with left main disease. The timing of surgery following percutaneous coronary intervention (PCI) depends on whether a stent was used, the type of stent, and the antiplatelet regimen.