This algorithm is to be used for patients ≥55 years of age or with risk factors for CAD (ie, family history of CAD, history of tobacco use, hyperlipidemia, diabetes mellitus, male sex, chronic kidney disease, other vascular disease).
Use this algorithm in conjunction with UpToDate content on estimation of cardiac risk prior to noncardiac surgery; perioperative management of patients with valvular heart disease, heart failure, and arrhythmias; and interpretation of stress testing.CAD: coronary artery disease; MACE: major adverse cardiac events; RCRI: revised cardiac risk index; MICA: myocardial infarction or cardiac arrest; MET: metabolic equivalent.
* Acute coronary syndrome includes acute myocardial infarction or unstable angina.
¶ The Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) calculator.
Δ Functional capacity is usually described in terms of METs. Perioperative cardiac risk is elevated in patients incapable of 4 METs during daily activity. Examples of 4 METS of activity include walking up >1 flight of stairs at a normal pace without stopping, walking on level ground at 4 miles per hour.
◊ Test results may affect the patient's decision to undergo the planned surgery, but may not affect care if the patient is unwilling to undergo treatment for abnormalities (eg, coronary revascularization). Test results may also affect decisions about the extent or appropriateness of planned surgery, alternative treatment, perioperative monitoring, and perioperative medical management.
§ Other cardiac tests may be indicated (eg, echocardiogram, holter monitor) based on suspected or known cardiac disease other than CAD.
¥ Not all abnormal stress test findings warrant further evaluation and treatment, or management that would delay surgery.