What is the ASA (American Society of Anesthesiologists) physical status classification for a patient with a history of two prior myocardial infarctions, two coronary stents, and ongoing exertional angina with limited walking?

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From the Guidelines

The patient's condition, characterized by a history of two prior myocardial infarctions, two coronary stents, and ongoing exertional angina with limited walking, would be classified as ASA III (American Society of Anesthesiologists physical status 3). This classification is based on the understanding that the patient has severe systemic disease that limits activity but is not incapacitating. The patient's cardiac history, as described, indicates significant cardiovascular disease with functional limitations due to exertional angina that restricts walking ability. According to the CCS grading scale mentioned in the study by 1, the patient's symptoms align with Class III, indicating marked limitation of ordinary physical activity, where angina occurs on walking 1 to 2 blocks on the level and climbing 1 flight of stairs in normal conditions and at a normal pace.

Given the information provided and the focus on the ASA classification system, the key consideration is the patient's functional capacity and the severity of their systemic disease. The ASA III classification reflects a patient with significant disease that limits activity but does not render them incapacitated or bedridden, which aligns with the patient's ability to walk, albeit with limitations due to angina. The study by 1 provides a framework for understanding the severity of angina and its impact on physical activity, supporting the classification of this patient as ASA III.

The distinction between ASA classifications, particularly between ASA III and ASA IV, hinges on the degree of limitation and the impact of the disease on the patient's daily life and physical capabilities. ASA IV represents patients with severe systemic disease that is a constant threat to life, which does not align with the description provided for this patient. Therefore, based on the most recent and relevant evidence, the patient should be classified as ASA III, reflecting their significant but not incapacitating systemic disease. This classification has important implications for anesthesia planning, emphasizing the need for careful preoperative evaluation and potentially additional cardiac testing to mitigate perioperative risks.

From the Research

ASA Physical Status Classification

The patient's history of two prior myocardial infarctions, two coronary stents, and ongoing exertional angina with limited walking suggests a significant cardiovascular comorbidity. Based on the ASA physical status classification system, this patient would likely be classified as:

  • ASA III: Patients with severe systemic disease, including cardiovascular disease, that limits activity but is not incapacitating. The patient's symptoms and medical history indicate a severe systemic disease that limits activity, but the fact that they are still able to walk, albeit with limited capacity, suggests that they are not incapacitated.

Rationale

The classification is based on the following considerations:

  • The patient has a history of two prior myocardial infarctions, which indicates a significant cardiovascular comorbidity 2.
  • The presence of two coronary stents suggests that the patient has undergone interventions to manage their cardiovascular disease 2.
  • The patient's ongoing exertional angina with limited walking indicates that their cardiovascular disease is not well-controlled and limits their physical activity 2.
  • Studies have shown that the ASA physical status classification system is a reliable predictor of postoperative outcomes, including morbidity and mortality 3.
  • The use of examples to assist in assigning ASA physical status classification has been shown to improve the accuracy of assignments 4.

Key Points

  • The patient's medical history and symptoms suggest a significant cardiovascular comorbidity.
  • The ASA physical status classification system is a widely used and reliable tool for assessing pre-anesthesia comorbid conditions.
  • The patient's classification as ASA III reflects their severe systemic disease that limits activity but is not incapacitating.
  • The use of examples and consideration of multiple factors can improve the accuracy of ASA physical status assignments 4, 3.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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