1. Is there an active cardiac condition?
  • Unstable coronary syndrome
    • Unstable or severe angina
    • Recent MI (<1 month)
  • Decompensated CHF
  • Significant arrhythmias
  • Severe valvular disease
Presence cancels or delays aneurysm repair until conditions treated. Implement medical management and consider coronary angiography.
2. Does the patient have good functional capacity without symptoms?
MET ≥4 (see Table IV)
Clinical risk factors:
  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes mellitus
  • Renal insufficiency
 May proceed with aneurysm repair. In patients with known cardiovascular disease or at least one clinical risk factor, beta blockade is appropriate.
3. Is functional capacity poor or unknown?
MET <4 (see Table IV)
Clinical risk factors:
  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes mellitus
  • Renal insufficiency
 In patients with three or more clinical risk factors, preoperative non-invasive testing is appropriate if it will change management.

CHF, Congestive heart failure; MET, metabolic equivalent unit; MI, myocardial infarction.

Adapted from Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 Guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary. Circulation 2007;116:1971-96.