According to the American College of Cardiology/AHA perioperative cardiac evaluation guidelines, which patient group should undergo pharmacological stress testing before elective non-cardiac surgery?

• A All patients with diabetes mellitus undergoing major vascular surgery
• B All patients older than 65 years undergoing intermediate-risk surgery
• C Patients with prior coronary stenting regardless of functional capacity
• D Patients with elevated surgical risk (>1% MACE) with poor/unknown functional capacity (<4 METs) where stress test results will change management ✓

Explanation

ACC/AHA 2014 perioperative guidelines use a stepwise approach. Stress testing is only indicated when: (1) the surgery has elevated risk (>1% MACE — major adverse cardiac event), (2) the patient has poor or unknown functional capacity (<4 METs — unable to climb stairs or walk on level ground), AND (3) the test results will change perioperative management (e.g., revascularisation, drug changes, or procedure cancellation). Good functional capacity (≥4 METs with no symptoms) allows surgery to proceed without stress testing regardless of clinical risk factors.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.