<div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1497908410" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{16}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">The</span><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">2026 ACC and AHA cardiovascular care </span><span class="NormalTextRun SCXW35996928 BCX0">guideline</span><span class="NormalTextRun SCXW35996928 BCX0">s</span><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">for noncardiac surgery </span><span class="NormalTextRun SCXW35996928 BCX0">replace the 2024 version with</span><span class="NormalTextRun SCXW35996928 BCX0"> unchanged</span><span class="NormalTextRun SCXW35996928 BCX0"> recommendations. </span><span class="NormalTextRun SCXW35996928 BCX0">The guidelines</span><span class="NormalTextRun SCXW35996928 BCX0"> cover selective cardiac testing, perioperative medication </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">management</span><span class="NormalTextRun SCXW35996928 BCX0"> and postoperative surveillance.</span></span><span class="NormalTextRun SCXW35996928 BCX0"></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="602099327" paraeid="{f84b94ac-063c-40b8-96a5-db3e0297c526}{149}"><span class="NormalTextRun SCXW35996928 BCX0">The American Heart Association (AHA) and American College of Cardiology (ACC) reaffirmed their recommendations after a review of evidence published through March 2026 found no need for changes to the guidelines.</span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1260493620" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{20}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">“Little evidence exists to support extensive preoperative testing in patients planned for low-risk surgeries, and care is rarely improved by additional cardiovascular testing,” wrote first author Annemarie Thompson, MD, MBA, of Duke University Hospital in Durham, North Carolina, and colleagues. Thompson chaired the </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">guideline’s</span><span class="NormalTextRun SCXW35996928 BCX0"> writing and surveillance committees.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1110469043" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{24}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">“</span><span class="NormalTextRun SCXW35996928 BCX0">This is particularly true for very low-risk procedures, including cataract and other ophthalmology surgeries, dental procedures, endoscopic procedures and skin biopsies.”</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="648658250" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{28}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Assessing </span><span class="NormalTextRun SCXW35996928 BCX0">p</span><span class="NormalTextRun SCXW35996928 BCX0">reoperative </span><span class="NormalTextRun SCXW35996928 BCX0">c</span><span class="NormalTextRun SCXW35996928 BCX0">ardiac </span><span class="NormalTextRun SCXW35996928 BCX0">r</span><span class="NormalTextRun SCXW35996928 BCX0">isk</span></span></strong></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="430757491" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{32}"><span class="NormalTextRun SCXW35996928 BCX0">Published in the </span><em><span class="NormalTextRun SCXW35996928 BCX0">Journal of the American College of Cardiology</span></em><span class="NormalTextRun SCXW35996928 BCX0"> and copublished in </span><em><span class="NormalTextRun SCXW35996928 BCX0">Circulation</span></em><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">, the guideline </span><span class="NormalTextRun SCXW35996928 BCX0">advocate</span><span class="NormalTextRun SCXW35996928 BCX0">d</span><span class="NormalTextRun SCXW35996928 BCX0"> a stepwise assessment to </span><span class="NormalTextRun SCXW35996928 BCX0">determine</span><span class="NormalTextRun SCXW35996928 BCX0"> whether surgery c</span><span class="NormalTextRun SCXW35996928 BCX0">ould</span><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">proceed</span><span class="NormalTextRun SCXW35996928 BCX0"> or should pause for further cardiovascular evaluation. </span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1791191809" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{36}"><span class="NormalTextRun SCXW35996928 BCX0">Screening and treatment should follow the same indications used in nonsurgical patients, with testing chosen carefully to avoid unnecessary procedures and surgical delays.</span><span class="NormalTextRun SCXW35996928 BCX0"></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1338490424" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{40}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Routine stress testing </span><span class="NormalTextRun SCXW35996928 BCX0">wa</span><span class="NormalTextRun SCXW35996928 BCX0">s not recommended for patients at low cardiovascular risk, those with adequate functional capacity and stable symptoms, or those undergoing low-risk procedures. </span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1710030239" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{44}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Testing may be considered when surgery carries elevated </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">risk</span><span class="NormalTextRun SCXW35996928 BCX0"> and patients have poor or unknown functional capacity plus elevated cardiovascular risk on a validated assessment tool.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="547974326" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{49}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">For patients with drug-eluting coronary stents who need elective surgery requiring interruption of one or more antiplatelet agents, surgery should ideally be delayed for at least 12 months after </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">stenting for</span><span class="NormalTextRun SCXW35996928 BCX0"> acute coronary syndrome. </span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1338682126" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{53}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">A delay of at least six months </span><span class="NormalTextRun SCXW35996928 BCX0">wa</span><span class="NormalTextRun SCXW35996928 BCX0">s reasonable after </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">stenting for</span><span class="NormalTextRun SCXW35996928 BCX0"> chronic coronary disease. Multidisciplinary decisions should balance the risks of bleeding and thrombosis against the consequences of postponing noncardiac surgery.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1790173927" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{57}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Managing </span><span class="NormalTextRun SCXW35996928 BCX0">p</span><span class="NormalTextRun SCXW35996928 BCX0">erioperative </span><span class="NormalTextRun SCXW35996928 BCX0">m</span><span class="NormalTextRun SCXW35996928 BCX0">edication </span><span class="NormalTextRun SCXW35996928 BCX0">r</span><span class="NormalTextRun SCXW35996928 BCX0">isks</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1190598397" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{59}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Medication management </span><span class="NormalTextRun SCXW35996928 BCX0">wa</span><span class="NormalTextRun SCXW35996928 BCX0">s another focus, including the perioperative risks associated with therapies for diabetes and heart failure. </span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="85027313" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{63}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">“New therapies for </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">management of</span><span class="NormalTextRun SCXW35996928 BCX0"> diabetes, heart failure, and obesity have significant perioperative implications. Sodium-glucose cotransporter 2 inhibitors should be </span><span class="NormalTextRun SCXW35996928 BCX0">discontinued</span><span class="NormalTextRun SCXW35996928 BCX0"> 3 to 4 days before surgery to minimize the risk of perioperative ketoacidosis associated with their use</span><span class="NormalTextRun SCXW35996928 BCX0">,” the guidelines state.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="880496657" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{67}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">The guideline also advised </span><span class="NormalTextRun SCXW35996928 BCX0">that </span><span class="NormalTextRun SCXW35996928 BCX0">b</span><span class="NormalTextRun SCXW35996928 BCX0">ridging oral anticoagulation should be reserved for selected patients at the highest thrombotic risk.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="539408920" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{71}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Monitoring </span><span class="NormalTextRun SCXW35996928 BCX0">p</span><span class="NormalTextRun SCXW35996928 BCX0">atients </span><span class="NormalTextRun SCXW35996928 BCX0">a</span><span class="NormalTextRun SCXW35996928 BCX0">fter </span><span class="NormalTextRun SCXW35996928 BCX0">s</span><span class="NormalTextRun SCXW35996928 BCX0">urgery</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="135922680" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{75}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">The document also recommend</span><span class="NormalTextRun SCXW35996928 BCX0">ed</span><span class="NormalTextRun SCXW35996928 BCX0"> close follow-up for patients with atrial fibrillation first diagnosed during or after surgery, including assessment for long-term anticoagulation. </span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1763107880" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{79}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">For selected patients undergoing elevated-risk surgery, troponin </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">measurement</span><span class="NormalTextRun SCXW35996928 BCX0"> at 24 and </span><span class="NormalTextRun SCXW35996928 BCX0">48 hours</span><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">after surgery </span><span class="NormalTextRun SCXW35996928 BCX0">may be reasonable to </span><span class="NormalTextRun SCXW35996928 BCX0">identify</span><span class="NormalTextRun SCXW35996928 BCX0"> myocardial injury. These include</span><span class="NormalTextRun SCXW35996928 BCX0">d</span><span class="NormalTextRun SCXW35996928 BCX0"> patients with known cardiovascular disease, suggestive </span><span class="NormalTextRun SCXW35996928 BCX0">symptoms</span><span class="NormalTextRun SCXW35996928 BCX0"> or age 65 or older with cardiovascular risk factors. Outpatient follow-up after myocardial injury </span><span class="NormalTextRun SCXW35996928 BCX0">wa</span><span class="NormalTextRun SCXW35996928 BCX0">s reasonable to </span><span class="NormalTextRun SCXW35996928 BCX0">optimize</span><span class="NormalTextRun SCXW35996928 BCX0"> cardiovascular risk factors.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="775672585" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{83}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">The authors </span><span class="NormalTextRun SCXW35996928 BCX0">identif</span><span class="NormalTextRun SCXW35996928 BCX0">ied</span><span class="NormalTextRun SCXW35996928 BCX0"> continuing evidence gaps, including the </span><span class="NormalTextRun SCXW35996928 BCX0">optimal</span><span class="NormalTextRun SCXW35996928 BCX0"> treatment of myocardial injury after surgery and the best strategies for managing postoperative atrial fibrillation. More randomized trials </span><span class="NormalTextRun SCXW35996928 BCX0">we</span><span class="NormalTextRun SCXW35996928 BCX0">re needed to define perioperative blood pressure targets and clarify which interventions improve</span><span class="NormalTextRun SCXW35996928 BCX0">d</span><span class="NormalTextRun SCXW35996928 BCX0"> outcomes.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335551550":6,"335551620":6,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="161567908" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{88}"><strong><span class="NormalTextRun SCXW35996928 BCX0">Source:</span></strong></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" paraid="1824486923" paraeid="{3de1d990-e387-4952-8fd9-2a554b5bee5d}{92}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Thompson A, Fleischmann KE, Smilowitz NR, et al. 2026</span><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. </span></span><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">J Am Coll </span><span class="NormalTextRun SpellingErrorV2Themed SCXW35996928 BCX0">Cardiol</span><span class="NormalTextRun SCXW35996928 BCX0">. </span></span><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">2026</span><span class="NormalTextRun SCXW35996928 BCX0"> September</span></span><span class="NormalTextRun SCXW35996928 BCX0">.</span><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0"> </span><span class="NormalTextRun SCXW35996928 BCX0">(</span><span class="NormalTextRun SCXW35996928 BCX0">Article in </span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW35996928 BCX0">Press</span><span class="NormalTextRun SCXW35996928 BCX0">)</span><span class="NormalTextRun SCXW35996928 BCX0">.</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335559739":0,"335559740":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW35996928 BCX0"> <p class="Paragraph SCXW35996928 BCX0" lang="EN-US" paraid="1931709500" paraeid="{4ca95e5e-235b-4cae-95a1-82e6b2748f5b}{147}"><strong><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun MacChromeBold SCXW35996928 BCX0"><span class="NormalTextRun SCXW35996928 BCX0">Image Credit: </span><span class="NormalTextRun SpellingErrorV2Themed SCXW35996928 BCX0">InfiniteFlow</span><span class="NormalTextRun SCXW35996928 BCX0"> – stock.adobe.com</span></span><span class="EOP Selected SCXW35996928 BCX0" data-ccp-props="{"134245529":true,"201341983":0,"335559739":0,"335559740":240}"> </span></strong></p> </div>