Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery

Abstract

Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

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High-sensitivity troponin T levels before and after cardiac surgery and the 30-day mortality: a retrospective cohort study

“…Although heart surgery remains the best hope for improving the physical condition and prolonging the life of heart patients, the associated complications cannot be ignored ( 2 , 3 ). While hemorrhage, craniocerebral injury, and pleural effusion are the most common postoperative complications, myocardial injury is also a complication that warrants medical attention ( 4 ). To clinically evaluate the existence and severity of myocardial injury, the detection of cardiac troponin or creatine kinase MB in serum/plasma is the most commonly used approach.…”