Preoperative cardiovascular testing should be reserved for patients with poor functional capacity undergoing high-risk noncardiac surgery where results will alter management.
Supports selective preoperative testing only when results alter management in high-risk cases; leaves open need for prospective validation.
Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.
No takes yet. Share an insight, caveat, or question.
Smilowitz et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: