Further Testing?
With poor or unknown functional capacity, the clinician should consult with the patient and perioperative team to determine whether further testing will impact patient decision making (e.g., decision to perform original surgery or willingness to undergo CABG or PCI, depending on the results of the test) or perioperative care.
Further testing could reveal underlying coronary artery disease. Knowledge of that underlying coronary artery disease could potentially improve management of the patient and avoid peri/post-operative major adverse cardiac event. However, that same knowledge of coronary disease might lead to revascularization intervention which the patient might not desire, and revascularization interventions all require various delays to permit healing (see this app's review of ACC's recommendations on timing of surgery after MI, stent, CABG), a delay which might not be clinically permissible.
Therefore this step asks whether further testing makes any sense. Asking this question could prompt the patient and clinician team to accept higher risks and proceed with surgery, it could prompt the patient and clinician team to choose an alternative to surgery (chemo & radiation for cancer, for example), or might prompt all concerned to perform further coronary testing.