CLINICIAN GUIDE · PERIOPERATIVE CARDIAC ASSESSMENT · SECTION 2 OF 3
Select useful tests and coordinate medication decisions.
Routine stress testing is not indicated for low-risk surgery, low predicted cardiac risk, or adequate functional capacity with stable symptoms. Consider testing selectively when risk is elevated, functional capacity is poor/unknown, and the result would change care.
Echo is useful for new unexplained dyspnea, suspected important valve disease, or a meaningful clinical change; avoid routine repeat imaging in a stable patient merely for a form.
[1][2]Identify the PCI date, indication, stent details, and antiplatelet regimen. Elective surgery requiring interruption after a drug-eluting stent is generally delayed at least 12 months after DES PCI for ACS or 6 months after DES PCI for chronic coronary disease; time-sensitive cases need individualized multidisciplinary assessment.
Do not independently stop dual antiplatelet therapy after recent PCI. Balance bleeding, stent thrombosis, and surgical delay with the treating cardiologist and procedural team.
[1]Generally continue established therapy; do not start a beta blocker on the day of surgery solely for prophylaxis
Hold 3–4 days before elective surgery according to the specific agent and team protocol
Plan around indication, BP, HF status, and anesthesia; avoid a universal instruction
Specify last dose and restart, based on bleeding risk, thrombotic indication, renal function, and anesthesia
Coordinate aspiration-risk assessment and local anesthesia instructions
Bridging is unnecessary for most anticoagulated patients and can increase bleeding; reserve it for selected high-thrombotic-risk circumstances. GLP-1 guidance is individualized: current multisociety advice allows many patients to continue, while local and higher-risk protocols may differ.
[1][5][6]Adult clinician education · References reviewed October 11, 2026.