Preoperative cardiac evaluation

Each year in the United States nearly 30 million patients are estimated to undergo noncardiac surgery, and about one third of these patients have coronary artery disease (CAD) or risk factors for CAD [1]. About 1 million of those patients have perioperative cardiac complications that result in more than $20 billion in health care expenditures [1]. The current standards for preoperative cardiac evaluation of these patients are the guidelines published by the American Col-lege of Cardiology (ACC) and the American Heart Association (AHA), initially in 1996 [2] and updated in 2002 [3]. These guidelines were developed based on a review of the then-available literature and the opinions of experts from the disciplines of anesthesiology, cardiology, electrophysiology, vascular medicine, vascular surgery, and noninvasive cardiac testing. The guidelines provided an eight-step algorithm for stratifying patients ’ risks and triaging patients to surgery or cardiac evaluation. Unless the proposed surgery is emergent, in which case the patient needs to be taken to the operating room without any delay for preoperative cardiac evaluation