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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Exercise or pharmacologic stress testing prior to noncardiac surgery Class IIa - The evidence or opinion is in favor of benefit from exercise or pharmacological stress testing prior to noncardiac in the following setting • For evaluation of patients scheduled to undergo vascular surgery with three or more clinical risk factors and poor functional capacity (<4 METS) if it will change management Class IIb - The weight of evidence or opinion is less well established for the benefit of exercise or pharmacological stress testing prior to noncardiac surgery in the following settings • For evaluation of patients scheduled to undergo intermediate-risk surgery with at least one clinical risk factor and poor functional capacity (<4 METS) if it will change management • For evaluation of patients scheduled to undergo vascular surgery with at least one clinical risk factor and good functional capacity (≥4 METS) Class III - There is evidence and/or general agreement that exercise or pharmacological stress testing prior to noncardiac surgery is not useful in the following settings • For evaluation of patients scheduled to undergo intermediate-risk surgery with no clinical risk factors • For evaluation of patients scheduled to undergo low-risk noncardiac surgery 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.