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Preoperative cardiac risk assessment — ABIM Board MCQ

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HardGeneral Internal MedicinePreoperative cardiac risk assessmentABIM Board

A 71-year-old with poor functional capacity is scheduled for elective open vascular surgery. A validated calculator estimates elevated perioperative cardiac risk. He has no acute coronary syndrome, decompensated heart failure or unstable arrhythmia. When is preoperative stress testing appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Reserve stress testing for results that would change management

The best answer is “Reserve stress testing for results that would change management”. In elevated-risk surgery with poor or unknown functional capacity and elevated calculated cardiac risk, stress testing may be considered when its result would alter decisions such as proceeding, revascularization for an independent indication, or perioperative planning. Testing without decision consequence is low value. Functional capacity alone neither mandates angiography nor automatically cancels surgery.

Reference: 2024 AHA/ACC Perioperative Cardiovascular Management Guideline: https://www.heart.org/-/media/PHD-Files-2/Science-News/Clinical-Update-Slides/2024-Guideline-for-Perioperative-Cardiovascular-Management-slide-set.pdf