2007 Car​diac Algorithm - Step 5

What is the level of surgical procedure risk?

Intermediate Risk

Non-emergency surgery
No active cardiac conditions
Mod-to-high risk surgery
Poor/unknown functional capacity
3-5 clinical risk factors
Intermediate risk surgery

Clinician has two options:

1) Proceed to O.R. with beta-blockade for heart rate control
-or-
2) Consider non-invasive coronary evaluation, i.e. stress test, if it will change management

High Risk (vascular surgery)

Non-emergency surgery
No active cardiac conditions
Mod-to-high risk surgery
Poor/unknown functional capacity
3-5 clinical risk factors
High risk surgery

Consider non-invasive coronary evaluation, i.e. stress test, if it will change management.

Consider beta-blockade and statin as each has recommendation for these patients having vascular surgery.

Surgical risk levels

Intermediate Risk Procedures 
(1-5% cardiac morbid & mortal)

  • intra-peritoneal/thoracic surgery
  • carotid endarterectomy
  • head and neck surgery
  • orthopedic, prostate surgery

High Risk Procedures 
(>5% cardiac morbid & mortal)

  • aortic & other major vessel surgery
  • peripheral vascular surgery

Low risk procedures not repeated here from Step 3 because if the surgery risk were low, one would not proceed to reach these questions at Step 5.