2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
American College of Cardiology Foundation American Heart Association Task Force on Practice Guidelines American Society of Echocardiography American Society of Nuclear Cardiology Heart Rhythm Society Society of Cardiovascular Anesthesiologists Society for Cardiovascular Angiography and Interventions Society for Vascular Medicine Society for Vascular Surgery,
Lee A. Fleisher, MD, FACC, FAHA, Chair,
Joshua A. Beckman, MD, FACC*,
Kenneth A. Brown, MD, FACC, FAHA ,
Hugh Calkins, MD, FACC, FAHA ,
Elliot L. Chaikof, MD ,
Kirsten E. Fleischmann, MD, MPH, FACC,
William K. Freeman, MD, FACC||,
James B. Froehlich, MD, MPH, FACC,
Edward K. Kasper, MD, FACC,
Judy R. Kersten, MD, FACC¶,
Barbara Riegel, DNSc, RN, FAHA,
John F. Robb, MD, FACC#
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Figure 3 Proposed Treatment for Patients Requiring Percutaneous Coronary Intervention (PCI) Who Need Subsequent Surgery
ACS indicates acute coronary syndrome; and MI, myocardial infarction.
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See Class III recommendations in Section 5.2.3. Noninvasive Stress Testing. 
See Table 3 for estimated MET level equivalent. 
Noninvasive testing may be considered before surgery in specific patients with risk factors if it will change management. ||Clinical risk factors include ischemic heart disease, compensated or prior heart failure, diabetes mellitus, renal insufficiency, and cerebrovascular disease. ¶Consider perioperative beta blockade (see Table 11) for populations in which this has been shown to reduce cardiac morbidity/mortality. ACC/AHA indicates American College of Cardiology/American Heart Association; HR, heart rate; LOE, level of evidence; and MET, metabolic equivalent.