A 55-year-old woman requires an abdominoperineal operation for rectal cancer. She has a history of stable angina. Which of the following clinical markers is most likely to predict a cardiac event during her noncardiac surgery and should prompt fuher cardiac workup prior to her operation?

The planned operation is a high-risk procedure.Patients can be stratified as having major, intermediate, or mild predictors of having a cardiac event. Major predictors include unstable angina, recent myocardial infarction, decompensated congestive hea failure, significant arrhythmias, and severe valvular disease. Intermediate predictors include mild angina, prior myocardial infarction, compensated or prior congestive hea failure, diabetes, and renal insufficiency. Minor predictors include advanced age, abnormal electrocardiogram, irregular rhythm, poor functional capacity, prior stroke, and uncontrolled hypeension.