Patient selection: no active cardiac conditions and one of the following: (1) low risk noncardiac, (2) intermediate risk noncardiac or (3) vascular surgery
Parameters:
(1) type of surgery
(2) functional capacity in METs
(3) number of clinical risk factors
(4) recent history
Stress echocardiography would be inappropriate if:
(1) surgery is low risk
(2) surgery is intermediate risk or vascular AND
(2a) functional capacity is >= 4 METs (moderate to good) AND no clinical risk factors
(2b) asymptomatic AND less than 1 year after a normal cardiac catheterization
(2c) asymptomatic AND less than 1 year after a normal noninvasive test
(2d) asymptomatic AND less than 1 year after a previous revascularization procedure and no active cardiac complaints
Stress echocardiography is uncertain if:
(1) surgery is intermediate risk AND (functional capacity < 4 METs or unknown)
(2) surgery is intermediate risk AND (1 or more clinical risk factors present)
Stress echocardiography is appropriate
(1) vascular surgery AND (functional capacity < 4 METs or unknown)
(2) vascular surgery AND (1 or more clinical risk factors present)
(3) symptomatic
where:
• A patient who is asymptomatic but more than a year from any of the listed conditions is not shown. Item 2d would be the most significant of these.
