Noncardiac Surgery Planned
Cardiac risk assessment needed
All Pathways
CardiologyRisk Assessment
Preoperative Cardiac Risk Assessment (ESC 2022)
Preoperative Cardiac Risk Assessment (ESC 2022): Noncardiac Surgery Planned → Calculate RCRI → RCRI Score? → RCRI 0 (0.4% MACE) → Proceed to Surgery.
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Action Calculate RCRI
Revised Cardiac Risk Index
- IHD (+1)
- HF (+1)
- Stroke/TIA (+1)
- Insulin DM (+1)
- Creatinine ≥2 (+1)
- High-risk surgery (+1)
03Decision RCRI Score?
Risk stratification
04Action RCRI 0 (0.4% MACE)
Low risk - proceed
05Outcome Proceed to Surgery
With appropriate risk mitigation
06Action RCRI ≥1: Assess METs
Functional capacity via DASI
- Can walk 2 blocks? 4 flights?
- <4 METs = Poor
- >10 METs = Excellent
07Decision Functional Capacity?
08Action ≥4 METs
Proceed to surgery
09Action Pre/Post-op Biomarkers
Known CVD or ≥65 yo
- hs-Troponin pre + post-op
- BNP/NT-proBNP pre-op
- Monitor for MINS
10Warning Medication Management
Key perioperative rules
- Continue statins
- Continue chronic beta-blockers
- Do NOT start BB day of surgery (Class III)
- Path rejoins step 05Shared downstream outcome
11Action <4 METs or Unknown
Further evaluation
- Consider cardiology consult
- Risk/benefit discussion
- Biomarkers (BNP, troponin)
- Path rejoins step 09Shared downstream outcome
Guideline Source
2022 ESC Guidelines on Cardiovascular Assessment for Non-Cardiac Surgery
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- RCRI calculator not integrated
- METs estimation simplified
- Does not replace cardiology consultation for complex patients
Contraindicated Populations
pediatric
Applicable Regions
EUUS
EU: ESC 2022 NCS guidelines
US: ACC/AHA periop guidelines similar
Version 1Next review: 2027-08-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Preoperative Cardiac Risk Assessment (ESC 2022)?
The Preoperative Cardiac Risk Assessment (ESC 2022) is a risk assessment clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2022 ESC Guidelines on Cardiovascular Assessment for Non-Cardiac Surgery.
What guideline is the Preoperative Cardiac Risk Assessment (ESC 2022) based on?
This algorithm is based on 2022 ESC Guidelines on Cardiovascular Assessment for Non-Cardiac Surgery (DOI: 10.1093/eurheartj/ehac270).
What are the limitations of the Preoperative Cardiac Risk Assessment (ESC 2022)?
Known limitations include: RCRI calculator not integrated; METs estimation simplified; Does not replace cardiology consultation for complex patients. Individual patient factors may require deviation from these recommendations.
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