The ACC/AHA guidelines recommend preoperative ECGs in patients with at least one clinical risk factor undergoing vascular surgical procedures, or patients with known coronary heart disease, peripheral arterial disease, or cerebrovascular disease undergoing at least intermediate-risk surgery. Age older than 65 years, history of heart failure, high cholesterol, angina, MI, or severe valvular disease are associated with clinically significant abnormalities on ECG.
Fleisher 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 (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation: 2007, 116(17);e418-99