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. 2020 Jan 27;9(2):351.
doi: 10.3390/jcm9020351.

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

Timur Yurttas  1 , Reka Hidvegi  1 , Miodrag Filipovic  1
Affiliations

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

Timur Yurttas et al. J Clin Med. .

Abstract

Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients' cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.

Keywords: cardiac biomarkers; perioperative myocardial infarction/injury; preoperative risk stratification.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Swiss algorithm for risk stratification prior to elective non-cardiac surgery; modified from Filipovic M, Kindler C, and Walder B. Swiss Med Forum. 2018;18(5152):1078-80. https://doi.org/10.4414/smf.2018.03440. With the kind approval of the Swiss Medical Publishers EMH. PCI: Percutaneous Coronary Intervention. metabolic equivalent; BNP: brain natriuretic peptide.
Figure 2
Figure 2
Swiss algorithm for risk stratification prior to emergent non-cardiac surgery; modified from Filipovic M, Kindler C, and Walder B. Swiss Med Forum. 2018;18(5152):1078-80. https://doi.org/10.4414/smf.2018.03440. With the kind approval of the Swiss Medical Publishers EMH. PCI: Percutaneous Coronary Intervention.
Figure 3
Figure 3
Proposed algorithm for perioperative myocardial injury/infarction based on the fourth definition of myocardial infarction [24]. 1 Ischemic features include signs or symptoms of acute myocardial ischemia, new ischemic ECG changes and/or development of pathological Q waves, imaging evidence of new wall motion abnormalities consistent with ischemic etiology. 2 Consideration of risk of bleeding after surgery. URL: Upper Range Limit; PCI: Percutaneous Coronary Intervention; ASS: acetylsalicylic acid.
See this image and copyright information in PMC

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