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Table 7-1 Lee’s Revised Cardiac Risk Index

Based on the American College of Cardiology/American Heart Association guidelines on perioperative evaluation for noncardiac surgery, cardiac risk factors can be segregated into two categories: active cardiac conditions (formerly known as major risk factors) and clinical risk factors (formerly known as intermediate risk factors) (Tables 7-2 and 7-3). Noncardiac surgical procedures are also stratified based on cardiac risk (Table 7-4).

Table 7-2 Active Cardiac Conditions
Table 7-3 Clinical Risk Factors
Table 7-4 Cardiac Risk Stratification for Noncardiac Surgical Procedures

The stepwise approach to perioperative cardiac assessment is based on the presence of cardiac risk factors, risk stratification of the surgical procedure, and patient’s functional capacity (Figure 7-1). Diagnostic evaluation and treatment is indicated for patients with active cardiac conditions (Table 7-2) such as unstable angina or decompensated heart failure. Additional diagnostic testing such as a stress test should also be considered in patients undergoing vascular procedures (Table 7-4) who suffer from three or more clinical risk factors (Table 7-3) and have poor functional capacity.

Figure 7-1. Stepwise Approach to Perioperative Cardiac Assessment

(A) See Table 7-3. (B) consider perioperative beta-blockade. Reprinted with permission ...

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