2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery
The 2024 guideline replaces the 2014 document and lands close to the ESC 2022 position: a stepwise algorithm driven by surgical risk, functional capacity and a validated risk index, with testing reserved for cases in which the result would change management. Like the ESC it recognises myocardial injury after noncardiac surgery (MINS) as a diagnosis, but it is more cautious about routine perioperative troponin surveillance and does not endorse it as broadly. It also gives explicit guidance on the perioperative handling of GLP-1 receptor agonists and SGLT2 inhibitors — drugs the European document predates. Much of the evidence base is negative, and the trials that closed questions are grouped below.
This guideline cites 6 of the 199 landmark trials in our Cardiology register.
Perioperative beta-blockade1
- 2008POISECardiology · Cardioprotection · Beta-blockadePeriOperative ISchemic Evaluation trial
Perioperative antithrombotic & antifibrinolytic therapy3
- 2022POISE-3Cardiology · Cardioprotection · Antifibrinolytic therapyPeriOperative ISchemic Evaluation-3 trial
- 2018MANAGECardiology · Cardioprotection · Antithrombotic therapyManagement of myocardial injury After NoncArdiac surGEry trial
- 2014POISE-2Cardiology · Cardioprotection · Aspirin and clonidinePeriOperative ISchemic Evaluation-2 trial