Multimodality imaging in cardiovascular evaluation of patients undergoing nonemergent, noncardiac surgery is the focus of new Appropriate Use Criteria (AUC) developed by the ACC and 10 other major cardiovascular societies.

The new AUC document is divided into three sections and includes six tables with the goal of guiding clinicians in the preoperative evaluation of patients undergoing noncardiac surgery and preventing cardiovascular events in the perioperative period.

Section 1 of the document focuses on scenarios with no known or suspected heart disease and no prior testing within 90 to 220 days. Section 2 involves scenarios in patients with known or suspected heart disease, but no prior testing within that same period. Lastly, Section 3 includes scenarios for the evaluation of patients with known or suspected heart disease in whom prior imaging has been performed within 90 to 220 days and sequential evaluation is being considered.

According to the Writing Group, chaired by John U. Doherty, MD, FACC, the 90 to 220 days timeframe is intended to "encompass the period of initial testing and any follow-up testing done to clarify a diagnosis." They caution that the "recommendations for imaging may not apply in other clinical circumstances, especially when the time horizon is much longer."

Ultimately, like all AUC, the document aims to help clinicians determine the most reasonable and appropriate course of action in evaluating patients. Given the great variability in clinical practice and conflicting evidence on the utility of preoperative imaging for risk assessment in patients undergoing noncardiac surgery, the authors note the scenarios "presented, although not all-inclusive, are meant to replicate what [is seen] daily in clinical practice."