Table 2

Clinical predicators of increased perioperative cardiovascular risk. Adapted from Eagle et al.71

MajorUnstable coronary syndromes:
•  Recent myocardial infarction with evidence of important ischaemic risk based on clinical symptoms or non-invasive study
•  Unstable or severe angina (grades 3 or 4)2-150
Decompensated congestive cardiac failure
Significant arrhythmias:
•  High grade atrioventricular block
•  Symptomatic ventricular arrhythmias in the presence of underlying heart disease
•  Supraventricular arrhythmias with uncontrolled ventricular rate
Severe valvular disease
IntermediateMild angina pectoris (grades 1 or 2)2-150
Prior myocardial infarction based on history or pathological Q waves
Compensated or prior congestive cardiac failure
Diabetes mellitus
MinorAdvanced age
Abnormal ECG findings (left ventricular hypertrophy, left bundle branch block, ST-T abnormalities)
Rhythm other than sinus (for example, atrial fibrillation)
Low functional capacity (for example, unable to climb one flight of stairs)
History of stroke
Uncontrolled systemic hypertension
  • 2-150 The Canadian Cardiovascular Society grading of angina pectoris75: Grade 1: Ordinary physical activity does not cause angina—such as walking or climbing stairs. Angina with strenuous or rapid or prolonged exertion at work or recreation. Grade 2: Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking up hill, walking or stair climbing after meals, or in cold, wind, or under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace or in normal conditions. Grade 3: Marked limitation of ordinary physical activity. Walking one or two blocks on the level and climbing one flight of stairs in normal conditions and a normal pace. Grade 4: Inability to carry on any physical activity without discomfort; anginal syndrome may be present at rest.