Perioperative cardiac biomarkers: the utility and timing

Abstract

Purpose of review: We presume that biomarkers will improve identification of patients at risk, leading to interventions and treatments that reduce perioperative adverse events. Risk stratification is multifactorial, and a biomarker must add information to this process, thereby redistributing patients to either higher or lower risk categories, to improve the allocation of expensive and risky interventions. This review focuses on the utility of three cardiac biomarkers in perioperative management.

Recent findings: Using newly defined epidemiologic criteria, three distinct molecules, brain natriuretic peptide (BNP), troponin (cTn), and glycosylated hemoglobin (HbA1c) emerge as potentially useful in perioperative medicine. A meta-analysis shows, in vascular surgery, BNP improves risk stratification. Four articles highlight the utility of postoperative cTn measurements in cases of myocardial injury. These articles show that most injury is not infarction, and they present preliminary evidence of the populations that will benefit from structured surveillance protocols. HbA1c is shown to improve the prediction of mortality, but there are questions whether this risk is modifiable.

Summary: The findings here suggest an expanded role for postoperative cTn surveillance; however, the precise populations that benefit, or the interventions required, are not yet defined. The encouraging data for the other two biomarkers need more investigations before adopting them into routine clinical use.