Clinical indices and biomarkers for perioperative cardiac risk stratification: an update

Area of Science:

• Cardiology
• Anesthesiology
• Biomarkers

Background:

• The European Society of Cardiology (ESC) and European Society of Anesthesiology (ESA) emphasized the anesthesiologist's critical role in perioperative cardiovascular assessment and management since 2014.
• Multidisciplinary collaboration among anesthesiologists, cardiologists, and surgeons is essential for comprehensive cardiovascular assessment.

Purpose of the Study:

• To outline the role of anesthesiologists in perioperative cardiovascular assessment.
• To highlight the utility of various scoring systems and cardiac biomarkers in clinical decision-making.
• To discuss the ongoing search for novel, more specific cardiac biomarkers.

Main Methods:

• Review of guidelines and literature regarding perioperative cardiovascular assessment.
• Discussion of established risk stratification tools such as the American Society of Anesthesiologists (ASA) Score, Lee Score, and NSQUIP database.
• Exploration of the application of cardiac biomarkers including troponins, C-reactive protein, and natriuretic peptides.

Main Results:

• Anesthesiologists are central to perioperative cardiovascular care, utilizing multidisciplinary input.
• Risk scores and a range of cardiac biomarkers provide valuable support for evidence-based decision-making.
• Current biomarkers, while helpful, are not ideal, driving research into more specific markers.

Conclusions:

• Cardiac biomarkers are fundamental to modern evidence-based medicine in anesthesiology.
• Optimizing perioperative cardiovascular management relies on accurate assessment and informed decision-making.
• Future research focuses on identifying highly specific biomarkers, such as heart-type fatty acid-binding protein and high-sensitivity troponins, to further enhance patient outcomes.