The past decade and a half has witnessed a culture change in perioperative cardiovascular evaluation and management. On the basis of landmark studies such as the Coronary Artery Revascularization Project (CARP)1 and the PeriOperative ISchemic Evaluation (POISE) trial,2 we have learned that practices such as routine preoperative coronary angiography and one-size-fits-all β-blockade are not beneficial (and, in the latter case, appear to be harmful). The most recent iteration of the American College of Cardiology/American Heart Association (ACC/AHA) perioperative guidelines advocates a relatively parsimonious approach to preoperative stress testing and advises caution with regard to initiating and titrating β-blockers.3
Bhave NM, Eagle KA. Trends in Perioperative Cardiovascular Events: Mostly Sunny, With Showers. JAMA Cardiol. 2017;2(2):188–189. doi:10.1001/jamacardio.2016.4786
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