Figure. Perioperative -Blockers: Patient Selection and Preoperative Risk Stratification

Revised Cardiac Risk Index criteria⁵ and minor clinical criteria adapted from Mangano et al⁴² are listed in Table 2. Revised Cardiac Risk Index criteria exclude patients with congestive heart failure because the safety and efficacy of perioperative -blockers has not been proven in these patients. Cardiac event rates with and without -blockade are ranges based on rates from Lee et al⁵ for cardiovascular complications observed in the validation set (those in the derivation set were somewhat lower) and on estimates from Boersma et al.⁶⁰ Options for noninvasive testing for further risk stratification include dipyramidole thallium scintigraphy, stress echocardiography, exercise electrocardiography, or cardiac catheterization in appropriate patients. Examples of activities that expend about 4 METS (metabolic equivalent tasks) include climbing 1 flight of stairs, being able to walk on level ground at 4 mph, or being able to climb a short hill without difficulty.