You are evaluating a 72-year-old man with a history of heart failure who is scheduled for noncardiac surgery. According to a recent study, which of the following measurements would MOST likely be associated with an increased risk of myocardial injury or death within 30 days of surgery in this patient?

Among surgical patients, a preoperative functional capacity assessment, including relevant plasma biomarker values, helps health care providers offer an informed consent with risk assessment. The Duke Activity Status Index (DASI) is a patient-administered questionnaire about physical activity that has been validated as a measure of cardiopulmonary fitness. However, threshold scores that should be used to define elevated perioperative risk have not yet been identified. Recently, a secondary analysis of data from the Measurement of Exercise Tolerance before Surgery (METS) study was used to evaluate the association between preoperative DASI scores and cardiovascular death or other complications.

The METS study included...

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