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Chasing myocardial outcomes: perioperative myocardial infarction and cardiac troponin
Marc B Royo1, Lee A Fleisher2,3
1Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-4865, USA. Marc.Royo@uphs.upenn.edu.
Insights
Perioperative myocardial infarction (PMI) often occurs silently after non-cardiac surgery. Elevated cardiac troponin levels after surgery indicate higher mortality risk, but clinical intervention strategies remain unclear.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Perioperative myocardial infarction (PMI) is the most frequent cardiovascular complication after non-cardiac surgery.
- PMI often presents asymptomatically, complicating diagnosis and management.
- Cardiac troponin elevation post-surgery is a marker for increased mortality.
Purpose of the Study:
- To review the evidence on cardiac troponin elevations in the perioperative setting.
- To discuss the integration of this evidence into current clinical practice guidelines.
- To explore the implications for detecting perioperative myocardial infarction.
Main Methods:
- This is a narrative review.
- Literature search on perioperative myocardial infarction and cardiac troponin.
- Analysis of current clinical practice guidelines.
Main Results:
- Cardiac troponin elevation is a significant predictor of mortality post-non-cardiac surgery.
- Clinical guidelines are evolving to address troponin elevations.
- Increased sensitivity of new troponin assays complicates interpretation.
Conclusions:
- Accurate detection of perioperative myocardial infarction is crucial.
- Further research is needed to clarify optimal clinical interventions for elevated troponin.
- Evolving biomarker technology impacts diagnostic and management strategies.
Abstract:
Perioperative myocardial infarction represents the most common cardiovascular complication following non-cardiac surgery, but frequently presents without the usual clinical signs and symptoms consistent with acute coronary syndrome. Given the silent nature of this event, a clinician's reliance on risk stratification tools and cardiac specific biomarkers to assist in the identification of at-risk individuals is heightened in the perioperative setting. Although cardiac troponin elevations following non-cardiac surgery have been consistently linked to increased mortality, uncertainty remains over how to clinically intervene to prevent harm. This decision is further complicated by the increasing sensitivity of the newest generation of cardiac biomarker immunoassays. In this narrative review, the growing body of evidence surrounding cardiac troponin elevations in the perioperative setting, how the evidence has been integrated into recent clinical practice guidelines, and its implications for the detection of perioperative myocardial infarction are discussed.
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