Table A1

Active Cardiac Conditions for Which the Patient Should Undergo Evaluation and Treatment Before Noncardiac Surgery (Class I, Level of Evidence: B)

ConditionExamples
Unstable coronary syndromesUnstable or severe angina (CCS class III or IV)
Recent MI
Decompensated HF (NYHA functional class IV; worsening or new-onset HF)
Significant arrhythmiasHigh-grade atrioventricular block
Mobitz II atrioventricular block
Third-degree atrioventricular heart block
Symptomatic ventricular arrhythmias
Supraventricular arrhythmias (including atrial fibrillation) with uncontrolled ventricular rate (HR >100 bpm at rest)
Symptomatic bradycardia
Newly recognized ventricular tachycardia
Severe valvular diseaseSevere aortic stenosis (mean pressure gradient >40 mm Hg, aortic valve area <1.0 cm2, or symptomatic)
Symptomatic mitral stenosis (progressive dyspnea on exertion, extertional presyncope, or HF)

Reprinted from Fleisher et al. (16).

CCS indicates Canadian Cardiovascular Society; HF, heart failure; HR, heart rate; MI, myocardial infarction; and NYHA, New York Heart Association.

  • According to Campeau (47);

  • May include “stable” angina in patients who are unusually sedentary;

  • The American College of Cardiology National Database Library defines recent MI as >7 days but ≤1 month (within 30 days).