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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Clinical predictors of increased perioperative cardiovascular risk (myocardial infarction, heart failure, death) Major predictors that require intensive management and may lead to delay in or cancellation of the operative procedure unless emergent • Unstable coronary syndromes including unstable or severe angina or recent MI • Decompensated heart failure including NYHA functional class IV or worsening or new-onset HF • Significant arrhythmias including high grade AV block, symptomatic ventricular arrhythmias, supraventricular arrhythmias with ventricular rate >100 bpm at rest, symptomatic bradycardia, and newly recognized ventricular tachycardia • Severe heart valve disease including severe aortic stenosis or symptomatic mitral stenosis Other clinical predictors that warrant careful assessment of current status • History of ischemic heart disease • History of cerebrovascular disease • History of compensated heart failure or prior heart failure • Diabetes mellitus • Renal insufficiency

• Severe heart valve disease including severe aortic stenosis or symptomatic mitral stenosis Other clinical predictors that warrant careful assessment of current status • History of ischemic heart disease • History of cerebrovascular disease • History of compensated heart failure or prior heart failure • Diabetes mellitus • Renal insufficiency Data from Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW; 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); 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; Society for Vascular Surgery. 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 Oct 23;50(17):e159-241.