Fig. 5.

Proposed algorithm to select patients who may benefit from a pre-operative stress test strategy. Both outcomes predictors and ischemic predictors must be considered during the preoperative evaluation before NCS. The suggested ischemic thresholds are 5.5% for sCMR and 7.5% for SPECT. The imaging stress test strategy is associated with a reduction in both MACE and ACS in the 30-day postoperative period. ACS acute coronary syndrome, CAD coronary artery disease, CI confidence intervals, CKD chronic kidney disease, DD diastolic dysfunction grade II and III, HTN hypertension, MACE major adverse cardiac events, METS metabolic equivalents, NCS non-cardiac surgery, OR odds ratio, sCMR stress cardiac magnetic resonance, SPECT single-photon emission computed tomography