Routine Preoperative ECG for Cardiac Risk Stratification Before Noncardiac Surgery: Scoping Review with ☸️SAIMSARA

Name: SAIMSARA Evidence Object vascular::PREOPERATIVE_ECG_SS
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara5e9e7a10

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Routine Preoperative ECG for Cardiac Risk Stratification Before Noncardiac Surgery: Scoping Review with ☸️SAIMSARA

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara5e9e7a10

Editorial note

• Last update: 2026-06-12 09:20:58

What is this paper about

Routine preoperative ECG remains a clinical paradox: often low-yield in low-risk noncardiac surgery, yet potentially powerful when combined with biomarkers and AI-driven waveform analysis. The full read shows where ECG can be safely de-implemented, where it still uncovers clinically relevant hidden disease, and how AI-ECG may redefine perioperative cardiac risk stratification.

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Abstract: To map the existing evidence on the clinical utility, prognostic value, and real-world application of routine preoperative ECG in adult patients undergoing noncardiac surgery, and to synthesize themes regarding its role in risk stratification, adherence to guidelines, and emerging technological enhancements. The review uses 42 references and builds its evidence map from 105 original studies with 4229860 total participants/sample observations (topic-deduplicated ΣN). This scoping review highlights a central paradox: the visually interpreted routine preoperative ECG offers limited incremental prognostic value for major adverse cardiac events in asymptomatic low-to-intermediate risk noncardiac surgery, yet its raw waveform may carry substantial untapped predictive signal. Conventional ECG abnormalities were frequently not independently associated with myocardial injury or MACE, and routine testing did not reduce cancellations in low-risk procedures. In contrast, AI-driven analysis of preoperative ECG waveforms was associated with markedly improved discrimination, with AUROCs up to 0.909 for 30-day mortality versus 0.728 for ESC guideline-based risk stratification and 0.725 for the RCRI. These findings suggest that future value lies less in traditional interpretation and more in selective, risk-factor-based testing alongside biomarker- and AI-enhanced strategies. The dominant uncertainty—whether AI-ECG tools improve patient outcomes—should be addressed through prospective multicenter validation trials before routine clinical adoption.
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Keywords: preoperative electrocardiogram; noncardiac surgery; perioperative risk assessment; routine ECG screening; cardiovascular risk prediction; preoperative testing guidelines; postoperative cardiac complications; deep learning ECG analysis; myocardial injury after noncardiac surgery; low-value preoperative care

Review Stats

Final search date and database lock: 2026-05-31 16:40:53 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 483
Downloaded Abstracts/Papers: 483
Included original and non-original Abstracts/Papers (all): 152
Included original Abstracts/Papers (Vote counting by direction of effect): 105
Reference Index (links used in paper): 42
Total participants/sample observations (topic deduplicated ΣN): 4229860

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Reference Index (42)

[1] Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization — https://doi.org/10.1161/circulationaha.117.030114
[2] Prognostic value of preoperative electrocardiography in predicting myocardial injury after vascular surgery. — https://doi.org/10.33963/kp.a2022.0085
[3] External validation of the PreOpNet deep learning algorithm for the prognosis of 30 days death and MACE: a European cohort — https://doi.org/10.1093/eurheartj/ehaf784.4047
[4] Preoperative risk prediction of major cardiovascular events in noncardiac surgery using the 12-lead electrocardiogram: an explainable deep learning approach. — https://doi.org/10.1016/j.bja.2025.07.085
[5] Discontinuing routine preoperative electrocardiogram testing in low-risk cataract surgery patients: the EliminECG quality improvement project. — https://doi.org/10.4103/singaporemedj.smj-2024-066
[6] Multimodal deep learning to predict postoperative major adverse cardiac and cerebrovascular events after noncardiac surgery — https://doi.org/10.1097/js9.0000000000003143
[7] Preoperative Cardiac Evaluation of Adult Patients Undergoing Noncardiac Surgery in Nepal: Multidisciplinary Consensus Recommendations from a Modified Delphi Study — https://doi.org/10.3126/nhj.v22i2.85785
[8] Evaluation of Preoperative Cardiology Consultations: Incidence, Characteristics and Implications for Perioperative Management — https://doi.org/10.29328/journal.jccm.1001160

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