If the patient has poor (<4 METs) or unknown functional capacity:
- then consult with the patient and surgeon to determine whether further testing will impact patient decision making (eg, decision to perform original surgery or willingness to undergo CABG or PCI, depending on the results of the test) or perioperative care. If yes, then pharmacological stress testing is appropriate.
If further cardiac evaluation is chosen;
- In patients with unknown functional capacity, try exercise stress testing or pharmacologic stress testing in patients with ambulatory disability. If the stress test is abnormal, consider coronary angiography and revascularization. The patient can then proceed to surgery or consider alternative strategies, such as noninvasive treatment (eg, radiation therapy for cancer) or palliation. If the test is normal, proceed to surgery.