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.
Interactive Decision Tree
Algorithm Steps
- ▶Start
Noncardiac Surgery Planned
Cardiac risk assessment needed
- ●Action
Calculate RCRI
Revised Cardiac Risk Index
- IHD (+1)
- HF (+1)
- Stroke/TIA (+1)
- Insulin DM (+1)
- Creatinine ≥2 (+1)
- High-risk surgery (+1)
- ◆Decision
RCRI Score?
Risk stratification
- ●Action
RCRI 0 (0.4% MACE)
Low risk - proceed
- ✓Outcome
Proceed to Surgery
With appropriate risk mitigation
- ●Action
RCRI ≥1: Assess METs
Functional capacity via DASI
- Can walk 2 blocks? 4 flights?
- <4 METs = Poor
- >10 METs = Excellent
- ◆Decision
Functional Capacity?
- ●Action
≥4 METs
Proceed to surgery
- ●Action
Pre/Post-op Biomarkers
Known CVD or ≥65 yo
- hs-Troponin pre + post-op
- BNP/NT-proBNP pre-op
- Monitor for MINS
- ⚠Warning
Medication Management
Key perioperative rules
- Continue statins
- Continue chronic beta-blockers
- Do NOT start BB day of surgery (Class III)
- ●Action
<4 METs or Unknown
Further evaluation
- Consider cardiology consult
- Risk/benefit discussion
- Biomarkers (BNP, troponin)
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
Applicable Regions
EU: ESC 2022 NCS guidelines
US: ACC/AHA periop guidelines similar
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
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.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Preoperative Cardiac Risk Assessment (ESC 2022) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free