American College of Cardiology

View all recommendations from this society

Updated January 11, 2021

Avoid performing stress testing, coronary calcium scoring, or advanced cardiac imaging as part of preoperative cardiovascular risk assessment in patients scheduled for low-risk non-cardiac surgery.

Non-invasive testing is not useful for patients undergoing low-risk non-cardiac surgery (that is, with a <1% combined clinical/surgical perioperative risk of myocardial infarction or death, e.g., cataract removal, endoscopy). These types of tests do not change the patient’s clinical management or outcomes and could result in increased costs and unnecessary downstream procedures.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Cardiology (ACC) asked its standing clinical councils to recommend between three and five procedures that should not be performed
or should be performed more rarely and only in specific circumstances. ACC staff took the councils’ recommendations and compared them to the ACC’s existing appropriate use criteria (AUC) and guidelines, choosing items for the five things list that were either Rarely Appropriate AUC recommendations or Class III guideline recommendations. The ACC’s Science and Quality Committee then reviewed and approved the final five items. ACC’s disclosure and conflict of interest policy can be found at


Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM, Min JK, Patel MR, Rosenbaum L, Shaw LJ, Stainback RF, Allen JM. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease. Journ Am Coll Cardiol. 2014 Feb;63(4);380-406.

Fleisher LA, Fleischmann KE, Auerback AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman M, Holly TA, Kane GC, Marine JE, Nelson T, Spencer CC, Thompson, A, Ting HH, Uretsky B, Wiievsundera D. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journ Am Coll Cardiol. 2014 December;64(22);77-137.