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Perioperative Cardiac Risk Assessment — EECC MCQ

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ModerateGeneral CardiologyPerioperative Cardiac Risk AssessmentEECC

A 70-year-old man with a history of MI and LVEF 40% is scheduled for elective hip replacement surgery. He is on optimal GDMT. His functional capacity is estimated at 4 METs (able to climb one flight of stairs without symptoms). According to the ESC guidelines on perioperative cardiac assessment, what additional cardiac testing is recommended before surgery?

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Correct answer: B — No additional cardiac testing is needed if the patient is on optimal medical therapy and the surgery is intermediate risk

The ESC Non-cardiac Surgery Guidelines (2022) recommend a stepwise approach: (1) Assess surgical risk (hip replacement = intermediate risk); (2) Assess clinical risk factors (prior MI, reduced LVEF); (3) Assess functional capacity (4 METs = moderate). For patients with moderate functional capacity (≥4 METs) undergoing intermediate-risk surgery on optimal medical therapy, additional preoperative cardiac testing is generally not required. Routine preoperative stress testing does not improve outcomes in this group and should be reserved for patients with poor or unknown functional capacity, high-risk surgery, or clinical instability. BNP/NT-proBNP measurement may be considered (Class IIb) but is not mandatory.

Reference: ESC (2022): Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management