Preoperative cardiac evaluation.

The current standards for preoperative cardiac evaluation and the guidelines published by the American College of Cardiology and the American Heart Association call for noninvasive or invasive cardiac evaluation in certain patients. Perioperative use of beta-adrenergic blockade has been shown to reduce cardiac complication rates, diminishing the positive predictive value and the likelihood ratio of a positive result of a preoperative cardiac test,unfavorably shifting the risk to benefit ratio of preoperative tests and any possible therapeutic action that one might take based on the test. A new paradigm might be emerging that makes cardiac tests unnecessary except in the highest-risk patients identified by clinical variables.