Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

Yurttas, Timur; Hidvegi, Reka; Filipovic, Miodrag

doi:10.3390/jcm9020351

Cited by 14 publications

(10 citation statements)

References 41 publications

(46 reference statements)

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“…В других странах придерживаются другого подхода, например, предложен так называемый «Швейцарский алгоритм» [12]. Оценка уровня BNP или NT-proBNP проводилась у пациентов с низким функциональным статусом, при нормальных значениях они могут быть подвергнуты хирургическому вмешательству без дальнейшего тестирования.…”

Section: биомаркерыunclassified

“…Последние годы характеризуются появлением новых рекомендаций в смежных областях (диагностика и лечение хронического коронарного синдрома [7], четвертое универсальное определение инфаркта миокарда [8]), а также публикацией большого числа работ по оценке риска некардиальных операций. Эксперты пришли к различным алгоритмам оценки и коррекции кардиального риска [9][10][11], несмотря на одинаковый исходный набор результатов исследований, что отражено в недавних обзорах [12,13]. Следствием этого стали публикации по валидизации новых алгоритмов и их сопоставлению с существовавшими ранее рекомендациями.…”

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Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

Sumin

2022

Racionalʹnaâ farmakoterapiâ v kardiologii

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Cardiovascular complications after non-cardiac surgery are the leading cause of 30-day mortality. The need for surgical interventions is approximately 5,000 procedures per 100,000 population, according to experts, the risks of non-cardiac surgical interventions are markedly higher in the elderly. It should be borne in mind that the aging of the population and the increased possibilities of medicine inevitably lead to an increase in surgical interventions in older people. Recent years have been characterized by the appearance of national and international guidelines with various algorithms for assessing and correcting cardiac risk, as well as publications on the validation of these algorithms. The purpose of this review was to provide new information about the assessment and correction of the risk of cardiac complications in non-cardiac operations. Despite the proposed new risk assessment scales, the RCRI scale remains the most commonly used, although for certain categories of patients (with oncopathology, in older age groups) the possibility of using specific questionnaires has been shown. In assessing the functional state, it is proposed to use not only a subjective assessment, but also the DASI questionnaire, 6-minute walking test and cardiopulmonary exercise test). At the next stage, it is proposed to evaluate biomarkers, primarily BNP or NT-proBNP, with a normal level – surgery, with an increased level – either an additional examination by a cardiologist or perioperative troponin screening. Currently, the prevailing opinion is that there is no need to examine patients to detect hidden lesions of the coronary arteries (non-invasive tests, coronary angiography), since this leads to excessive examination of patients, delaying the implementation of non-cardiac surgery. The extent to which this approach has an advantage over the previously used one remains to be studied.

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Section: биомаркерыunclassified

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Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

Sumin

2022

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…Pacientes con niveles normales puede someterse a cirugía sin más pruebas, mientras que los pacientes con elevación de BNP o NT-proBNP son de alto riesgo, deben someterse a un tratamiento cardiológico y la vigilancia de troponinas es recomendado diariamente durante 48 a 72 h. Un cambio de ≥ 20% se interpreta como significativo y se debe diferenciar si la injuria miocárdica es por causa isquémica o no isquémica. Si la causa es isquémica, se procede a la clasificación de infarto tipo I (ruptura de placa) o tipo II (desbalance entre oferta y demanda) [6]. Las guías de la CSC recomiendan obtener diariamente medidas de troponina durante 48-72 h después de la cirugía no cardíaca en pacientes con un riesgo inicial > 5% de muerte cardiovascular o IAM no mortal 30 días después de la cirugía, es decir, pacientes con una medición elevada de NT-proBNP/BNP antes de la cirugía o, si no hay medición de NT-proBNP / BNP antes de la cirugía, en aquellos que tienen una puntuación RCRI ≥ 1, de 45-64 años con enfermedad cardiovascular significativa o de 65 años o más [4].…”

Section: -Biomarcadoresunclassified

“…Sin embargo, a pesar de la eficacia demostrada de estos biomarcadores, no es posible realizarlos de forma rutinaria a todos los pacientes, actualmente, no hay un biomarcador que sea 100% específico y 100% sensible, y se pueden elevar en condiciones de ausencia real de isquemia miocárdica, por lo que tratar a pacientes por una condición no existente podría ser dañino [6], [7].…”

Section: -Biomarcadoresunclassified

Anestesia cardiovascular en cirugía no cardiaca

Borchert¹,

González²,

Lema³

2020

Rev. chil. anest.

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La valoración clínica sigue siendo uno de los pilares fundamentales en la evaluación del riesgo anestésico-quirúrgico. Los scores de riesgo para la evaluación cardiovascular y cirugía no cardíaca se basan tradicionalmente en la exclusión de condiciones cardíacas activas, la determinación del riesgo de cirugía, la capacidad funcional del paciente y la presencia de factores de riesgo cardíaco. En las últimas décadas, nuevas guías incorporan una asociación entre los biomarcadores cardiacos y los eventos cardiacos adversos. Para el manejo de pacientes coronarios en tratamiento antiagregante doble, derivados a cirugía no cardiaca, hay que considerar el riesgo de trombosis del stent, las consecuencias de retrasar el procedimiento quirúrgico y el aumento del riesgo de hemorragia. Hasta la fecha no existe evidencia acerca de cuál es el mejor manejo anestésico que disminuya las complicaciones cardiovasculares perioperatorias en este grupo de pacientes. Este artículo, hace referencia a las diferencias de la valoración preoperatoria para cirugía no cardiaca incorporados en las guías del American College of Cardiology, la American Heart Association, la European Society of Cardiology y la Canadian Cardiovascular Society. Algunas consideraciones acerca del manejo de pacientes coronarios, terapia antiplaquetaria dual y eventuales complicaciones. Se incluyen algunas estrategias farmacológicas, así como consideraciones específicas para el perioperatorio, con el fin de reducir morbilidad de origen cardiovascular.

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“…With the development of high-sensitivity troponin (Hs-TnI) for early diagnosis of perioperative acute myocardial infarction, etiological identification of perioperative myocardial injury and other related research[ 10 ], more biomarkers have been identified for use in cardiac risk assessment[ 11 , 12 ], but there is no widely recognized quantitative monitoring index of perioperative cardiac function[ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

Zhang¹,

Xie²,

Zhao³

et al. 2022

WJCC

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BACKGROUND Major adverse cardiac events (MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far. AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases. METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group. RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-I (Hs-TnI), creatine kinase isoenzyme (CK-MB), myoglobin (MYO), B-type natriuretic peptide (BNP), and D-dimer (D-D) levels were significantly increased ( P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic (ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively. CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

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Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery

Cited by 14 publications

References 41 publications

Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

Anestesia cardiovascular en cirugía no cardiaca

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

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