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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Preoperative Coronary Revascularization with either CABG or PCI Class I - There is evidence and/or general agreement that coronary revascularization should be performed with in the following settings • A patient with stable angina and a significant left main coronary artery stenosis • A patient with stable angina and significant three vessel disease • A patient with stable angina and significant two vessel disease with a significant proximal left anterior descending stenosis and either a left ventricular ejection fraction <50 percent or demonstrable ischemia on noninvasive testing • A patient with high risk unstable angina, NSTEMI or STEMI Class IIa - The weight of evidence or opinion is in favor of benefit from coronary revascularization in the following settings • A patient with angina not controlled with medical therapy who needs elective surgery in the next 12 months. In this setting balloon angioplasty or placement of a bare metal stent followed by dual antiplatelet therapy for four to six weeks is probably indicated • For patients with drug-eluting stents who must discontinue thieonpyridine therapy due to urgent surgery, it is reasonable to continue aspirin and restart the thienopyridine as soon as possible Class IIb - The weight of evidence or opinion is less well established for coronary revasuclarizaiton in the following settings • A high-risk ischemic patient (eg, abnormal dobutamine stress echocardiogram with at least five segments of wall-motion abnormalities) • A low risk ischemic patient with one to four abnormal segments on dobutamine stress-echocardiogram Class III - There is evidence and/or general agreement that coronary angiography is not useful in the following settings • A patient stable CAD • Elective non-cardiac surgery should not be performed within four to six weeks of coronary revascularization with a bare metal stent or within 12 months of a drug eluting stent in whom either thienopyridine therapy of both aspirin and thienopyridine therapy will need to be discontinued perioperatively • Elective non-cardiac surgery should not be performed within four weeks of coronary revascularization with balloon angioplasty

• Elective non-cardiac surgery should not be performed within four to six weeks of coronary revascularization with a bare metal stent or within 12 months of a drug eluting stent in whom either thienopyridine therapy of both aspirin and thienopyridine therapy will need to be discontinued perioperatively • Elective non-cardiac surgery should not be performed within four weeks of coronary revascularization with balloon angioplasty Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol 2007; 50:e159.