Home » 1) Cardiovascular Risk » Assessing Cardiac Risk of Noncardiac Surgery

Assessing Cardiac Risk of Noncardiac Surgery

Guiding Question:
How does the preoperative cardiac history differ from the chest pain or CAD cardiac history?


Preoperative cardiac risk assessment requires a comprehensive history and cardiovascular physical exam focused on identifying elements known to predict perioperative cardiovascular adverse events. This information along with basic labs is enough to estimate cardiac risk using one of the validated multivariate prediction rules.  The role of preoperative testing is limited to the group of patients in whom coronary revascularization would be indicated independent of the planned surgery.


Learning Objectives:

  • Assess cardiac risk using validated risk calculators (R1, R2, R3)
  • Perform preoperative cardiac testing in appropriate patients (R2, R3)


Review cases 1-4 for this section of the module.


Learning Resources:

  1. 2014 ACC Guidelines pgs 24-28 (assessment) and pgs 28-39 (testing)
  2. Derivation and Validation of the Revised Cardiac Risk Index (paper describing the RCRI or Lee criteria)
  3. Development and Validation of a Risk Calculator for Prediction of Cardiac Risk After Surgery (paper describing the NSQIP or Gupta criteria)
  4. UpToDate chapter on Estimation of Cardiac Risk Prior to Non-cardiac Surgery

Videos: (total viewing time 20:05)

  1. Preoperative Cardiac Risk Assessment (7:45)
  2. Comparison of RCRI and NSQIP Cardiac Risk Indices (5:45)
  3. Who Needs Preoperative Cardiac Testing? (7:05)

Annotated PowerPoint Slides: (Note: To download the slides click “Save” at the top of the presentation. After downloading, click on “View” tab and view as “Notes Page”)

  1. Overview of Preoperative Cardiac Risk Assessment for the General Internist (9 slides)
  2. Comparison of RCRI (Lee Criteria) and NSQIP (Gupta Criteria) Indices for Predicting Cardiac Risk of Major Noncardiac Surgery (5 slides )
  3. Who Needs Preoperative Noninvasive Cardiac Testing? (8 slides)