Preoperative and postoperative measurement of troponin and BNP in patients at risk for MACCE can help identify those that will go on to develop myocardial events. However, it is unclear which patients should be selected so that postoperative troponin surveillance would be effective. A prospective, single-center cohort study by Mases et al examined whether preoperative cardiac biomarkers could identify patients at highest risk for AMI. The authors also identified risk factors that further characterize patients. Baseline hsTnT and NT-proBNP, as well as hsTnT on the first 3 postoperative days were obtained. Seven hundred and thirty-two patients ≥45 years at risk for MACCE scheduled for intermediate-to-high-risk noncardiac surgery were studied. Of these, 22% had AMI defined by at least 1 hsTnT finding ≥30 ng/L and with a rise and/or fall of at least 20% of the baseline hsTnT concentration. Eighty-four had elevated baseline hsTnT, OR: 12.08 (95% CI, 7.78–9.42). Six other independent predictors for AMI were identified, including age, gender, GFR <45 mL·min−1·1.73 m−2, functional capacity <4 METs or unknown, NT-proBNP ≥ 300 pg/mL, and estimated intraoperative blood loss. A baseline hsTnT ≥ 14 ng/L strongly supports the need for postoperative troponin surveillance. For patients with baseline hsTnT <14 ng/L, the 6-predictor model identifies additional patients at risk for AMI who may also benefit from postoperative surveillance. The reader is strongly encouraged to review the cited article for an in-depth understanding of the concepts summarized in this infographic.

1. Mases A, Beltrán de Heredia S, Gallart L, et al. Prediction of acute myocardial injury in noncardiac surgery in patients at risk for major adverse cardiovascular and cerebrovascular events: a multivariable risk model. Anesth Analg. 2023;137:1116–1126.