*Active clinical conditions include unstable coronary syndromes, decompensated heart failure, significant arrhythmias, and severe valvular disorders. † See the ACC/AHA guidelines . ‡ Clinical risk factors include coronary artery disease, history of heart failure, history of cerebrovascular disease, diabetes mellitus, and preoperative creatinine > 2.0 mg/dL. ACC = American College of Cardiology; AHA = American Heart Association; HR = heart rate; MET = metabolic equivalent. Adapted from Fleisher LA, Beckman JA, Brown KA, et al: ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 116: e418–e500, 2007.