When biomarker(s) are abnormal, ACC recommends once again consideration by care team risks and benefits of further testing. If further testing is elected, consider the following structural and functional evaluation options:
Non-emergency surgery No acute coronary syndrome Elevated risk surgery Poor/unknown functional capacity Further testing desired Abnormal cardiac biomarker(s) Low-risk findings from further cardiac tests
Non-emergency surgery No acute coronary syndrome Elevated risk surgery Poor/unknown functional capacity Further testing desired Abnormal cardiac biomarker(s)
finally, either...
Hi-risk findings from further cardiac tests - or - Deferral of further cardiac testing
For these patients, all options are available for clinician and patient discussion including... - deferral of surgery - non-invasive or invasive treatment of cardiac conditions like CAD - palliative measures - proceeding to surgery as-is despite suboptimal circumstances
ACC also recommends that for those who head to surgery from this group, post-operative troponin testing can be considered (2b level recommendation).
Non-emergency surgery No acute coronary syndrome Elevated risk surgery Poor/unknown functional capacity Further testing desired Abnormal cardiac biomarker(s)
finally, either...
Hi-risk findings from further cardiac tests - or - Deferral of further cardiac testing
For these patients, all options are available for clinician and patient discussion including... - deferral of surgery - non-invasive or invasive treatment of cardiac conditions like CAD - palliative measures - proceeding to surgery as-is despite suboptimal circumstances
ACC also recommends that for those who head to surgery from this group, post-operative troponin testing can be considered (2b level recommendation).
ACC phrases each recommendation in the decision tree with the term "consider" and explicitly grades the stress test and CCTA recommendations as 2b.
