NMS. Casos Clínicos

15

Chapter 1 ♦ Preoperative Care

Patient scheduled for surgery with known or risk factors for CAD* (Step 1)

Clinical risk stratification and proceed to surgery

Emergency

Yes

No

Evaluate and treat according to GCMT†

ACS† (Step 2)

Yes

No

Estimated perioperative risk of MACE based on combined clinical/surgical risk (Step 3)

No further testing (Class IIa)

Excellent (>10 METs)

Proceed to surgery

Moderate or greater (≥4 METs) functional capacity

Low risk (<1%) (Step 4)

Elevated risk (Step 5)

Moderate/Good (≥4–10 METs)

No further testing (Class IIb)

No further testing (Class III:NB)

No or unknown

Poor unknown functional capacity (<4 METs): With further testing impact decision-making OR OR

Proceed to surgery

stress testing (Class IIa) Pharmacologic

Yes

perioperative care? (Step 6)

OR Proceed to surgery according to GDMT alternate strategies (noninvasive treatment, palliation) (Step 7) Figure 1-1: Stepwise approach to perioperative cardiac assessment for coronary artery disease (CAD). Colors correspond to the Classes of Recommendations in Table 1. Step 1: In patients scheduled for surgery with risk factors for or known CAD, determine the urgency of surgery. If an emergency, then determine the clinical risk factors that may influence perioperative management and proceed to surgery with appropriate monitoring and management strategies based on the clinical assessment (see Section 2.1 for more information on CAD). Step 2: If the surgery is urgent or elective, determine if the patient has SAMPLE No If normal If abnormal according to Coronary revascularization existing CPGs (Class I)