1. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Stepwise Approach to Perioperative Cardiac Assessment Cardiac evaluation and care algorithm for noncardiac surgery based on active clinical conditions, known cardiovascular disease, or cardiac risk factors for patients ≥50 years of age. HR = heart rate; LOE = level of evidence; MET = metabolic equivalent. Figure Legend:

2. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Suspected CAD: No Prior Noninvasive Stress Imaging A = appropriate; CAD = coronary artery disease; I = inappropriate; U = uncertain. Figure Legend:

3. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Suspected CAD: Prior Noninvasive Stress Testing Indications 22 to 27 not covered in figure. CAD = coronary artery disease; ECG = electrocardiography. Figure Legend:

4. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Suspected CAD: Prior Noninvasive Cardiac CT (Calcium Score and CTA) *Coronary calcium score only rated for asymptomatic patients as these patients are the population in which it is used. CT = computed tomography; CTA = computed tomography angiography. Figure Legend:

5. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Patients With Known Obstructive CAD CAD = coronary artery disease; PCI = percutaneous coronary intervention. Figure Legend:

6. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Evaluation of Arrhythmias Indication 63 for newly diagnosed LBBB is not represented in this figure and was rated as “uncertain.” CHD = coronary heart disease; LBBB = left bundle branch block; LV = left ventricular; NI = noninvasive; VF = ventricular fibrillation; VT = ventricular tachycardia. Figure Legend:

7. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Preoperative Coronary Evaluation: Patients With No Prior Noninvasive Stress Testing METS = metabolic equivalents. Figure Legend:

8. Date of download: 6/23/2016 Copyright © The American College of Cardiology. All rights reserved. From: ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 Appropriate Use Criteria for Diagnostic Catheterization: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons J Am Coll Cardiol. 2012;59(22):1995-2027. doi:10.1016/j.jacc.2012.03.003 Evaluation of Valvular Disease Preoperative assessment before valvular surgery is not represented in this figure and is rated “appropriate.” *Indication 90 for acute moderate or severe mitral or aortic regurgitation is not represented in this figure. Rating for concordant imaging is “uncertain” and conflicting imaging is “appropriate.” NI = noninvasive. Figure Legend: