| Intervention | Regimen and Remarks | Recommendations* |
|---|---|---|
| Perioperative βblockade | β-blockers should be continued in patients undergoing surgery who are receiving β-blockers for treatment of conditions with ACC/AHA Class I guideline indications for the drugs (revised based on harm from administration of extended release metoprolol in the POISE trial) | Class 1 |
| Titrated to heart rate and blood pressure (“probably recommended”) in vascular surgery patients who have high cardiac risk based on known coronary artery disease preoperative testing revealing cardiac ischemia | Class IIa | |
| Titrated to heart rate and blood pressure (“reasonable”) in vascular surgery patients who have high cardiac risk based on risk factors alone | Class IIa | |
| α2-Agonists | Pretreatment with 300 µg of oral clonidine at least 90 min before surgery and therapy continued for 72 h(oral or transdermal, 0.2 mg/d); 300 µg IV of clonidine can also be administered for 72 h | Class IIb |
| Statin therapy | Statins should be continued in patients already taking statins | Class IIa |
| Calcium channel blockers | Reduced perioperative adverse cardiac events | Class IIb |
| Nitroglycerin | Not indicated for myocardial ischemia prophylaxis or initial treatment; may be used to treat arterial hypertension or elevated cardiac filling pressures or suspected coronary vasospasm | Class III |
*Class I: evidence or general agreement that treatment is useful or effective.
Class IIa: weight of evidence or opinion is in favor of usefulness or efficacy.
Class IIb: usefulness or efficacy is less well established by evidence or opinion.
Class III: evidence or general agreement that the procedure or treatment is not useful or effective or in some cases may be harmful.
ACC = American College of Cardiology; AHA = American Heart Association; POISE = Perioperative Ischemic Evaluation Study.