In noncardiac surgery preoperative assessment, which factor best predicts perioperative cardiac risk?

• A. Age over 65
• B. History of myocardial infarction
• C. Functional status (≥4 METs)
• D. Chronic hypertension

Answer: (C)

Assessing how well a patient can tolerate the increased cardiac workload in the perioperative period is the most predictive measure. Functional status expressed in metabolic equivalents (METs) directly reflects cardiac reserve: if a patient can handle ≥4 METs—roughly brisk walking up stairs or doing light work without symptoms—their heart can usually meet surgical stress, and perioperative cardiac risk is lower. Other factors like age, prior myocardial infarction, or chronic hypertension contribute to risk, but they don’t gauge current functional reserve as effectively as METs do. In practice, checking METs helps tailor the need for further testing and perioperative planning based on actual functional capacity.