ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: 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)
*American Society of Echocardiography Official Representative.†American Society of Nuclear Cardiology Official Representative.‡Heart Rhythm Society Official Representative.§Society of Cardiovascular Anesthesiologists Official Representative.∥Society for Cardiovascular Angiography and Interventions Official Representative.¶Society for Vascular Medicine and Biology Official Representative.#Society for Vascular Surgery Official Representative.**Immediate Past Chair.††Task Force member during this writing effort.
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TABLE OF CONTENTSPreamble 686Definition of the Problem 688Purpose of These Guidelines 688Methodology and Evidence 689General Approach to the Patient 692History 693Physical Examination and Routine Laboratory Tests 693Multivariable Indices to Predict Preoperative Cardiac Morbidity 694Clinical Assessment 694Stepwise Approach to Perioperative Cardiac Assessment 695Disease-Specific Approaches 696Coronary Artery Disease 696Patients With Known CAD 696Hypertension 696Valvular Heart Disease 696Surgery-Specific Issues 697Supplemental Preoperative Evaluation 697Assessment of LV Function 697Assessment of Risk for CAD and Assessment of Functional Capacity 697The 12-Lead ECG 697Exercise Stress Testing for Myocardial Ischemia and Functional Capacity 698Noninvasive Stress Testing 698Perioperative Therapy 698Preoperative Coronary Revascularization With Coronary Artery Bypass Grafting or PCI 698Preoperative Coronary Artery Bypass Grafting 698Preoperative PCI 698PCI Without Stents: Coronary Balloon Angioplasty 698PCI: Bare-Metal Coronary Stents 699PCI: Drug-Eluting Stents 699Perioperative Management of Patients With Prior PCI Undergoing Noncardiac Surgery 699Perioperative Management in Patients Who Have Received Intracoronary Brachytherapy 700Strategy of Percutaneous Revascularization in Patients Needing Urgent Noncardiac Surgery 700Perioperative Medical Therapy 701Perioperative Beta-Blocker Therapy 701Titration of Beta Blockers 701Withdrawal of Beta Blockers 702Perioperative Statin Therapy 702Alpha-2 Agonists 702Perioperative Calcium Channel Blockers 702Intraoperative Electromagnetic Interference With Implantable Pacemakers and Cardioverter Defibrillators 702Anesthetic Considerations and Intraoperative Management 703Intraoperative Management 703Perioperative Pain Management 703Perioperative Surveillance 703Intraoperative and Postoperative Use of Pulmonary Artery Catheters 703Surveillance for Perioperative MI 703Postoperative and Long-Term Management 703Myocardial Infarction: Surveillance and Treatment 703Long-Term Management 704Conclusions 704Appendix I 705Appendix II 706Appendix III 710PreambleIt is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting the absolute and relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies.The American College of Cardiology (ACC) Foundation and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980. The ACC/AHA Task Force on Practice Guidelines, whose charge is to develop, update, or revise practice guidelines for important cardiovascular diseases and procedures, directs this effort. Writing committees are charged with the task of performing an assessment of the evidence and acting as an independent group of authors to develop, update, or revise written recommendations for clinical practice.Experts in the subject under consideration have been selected from both organizations to examine subject-specific data and write guidelines. The process includes additional representatives from other medical practitioner and specialty groups when appropriate. Writing committees are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered, as well as frequency of follow-up and cost-effectiveness.