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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Preoperative 12-lead rest electrocardiogram (ECG) prior to noncardiac surgery Class I - There is evidence and/or general agreement that a preoperative rest ECG should be obtained in the following setting • Patients with a least one clinical risk factor who require vascular surgical procedures • Patients with atherosclerotic cardiovascular disease scheduled for intermediate-risk procedures Class IIa - The evidence or opinion is in favor of usefulness of a preoperative rest ECG in the following setting • Patients with no clinical risk factors who require vascular surgical procedures Class IIb - The evidence or opinion is less well established for the usefulness of a preoperative rest ECG in the following settings • Patients with at least one clinical risk factor scheduled to undergo intermediate-risk procedures Class III - There is evidence and/or general agreement that preoperative rest and postoperative ECGs are not useful in the following setting • Asymptomatic patients who are scheduled for a low-risk operative procedures.

Class IIb - The evidence or opinion is less well established for the usefulness of a preoperative rest ECG in the following settings • Patients with at least one clinical risk factor scheduled to undergo intermediate-risk procedures Class III - There is evidence and/or general agreement that preoperative rest and postoperative ECGs are not useful in the following setting • Asymptomatic patients who are scheduled for a low-risk operative procedures. 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.