Perioperative Cardiovascular Evaluation
Current recommendations for perioperative cardiovascular evaluation and management for noncardiac surgery are based largely on clinical experience and observational studies, with few prospective RCTs. The GWC recommends that future research on perioperative evaluation and management span the spectrum from RCTs to regional and national registries to focus on patient outcomes.Routine perioperative stress testing in patients at low risk for cardiac events undergoing low-risk elective noncardiac surgery has no benefit, but it could have harm by exposing the patient to unnecessary treatments, such as medications or revascularization procedures. Alternatively, the interruption of perioperative medications such as statins and warfarin in situations not supported by evidence/perioperative CPGs can worsen patient outcomes. Diagnostic cardiovascular testing continues to evolve, with newer imaging modalities being developed, such as coronary calcium scores, computed tomography angiography, and cardiac magnetic resonance imaging. The value of these modalities in preoperative screening is uncertain and warrants further study.