Inflammation and Perioperative Cardiovascular Events

Surgery and anesthesia induce a stress response that provokes increased sympathetic stimulation, secretion of cortisol, hypercoagulability, and systemic inflammatory response. All these homeostatic deteriorations, especially systemic inflammation, represent a risk for organ damage. Perioperative cardiac complications have an increasing impact on morbidity and mortality, not only in cardiovascular but also in non-cardiac surgery. Surgical procedures represent a potential trigger for systemic inflammation that causes secretion of proinflammatory cytokines, activation of neutrophils, and tissue damage. Also, increased levels of preoperative inflammatory markers predict perioperative cardiovascular events. Systemic inflammatory biomarkers increase during the first days after surgical procedures and decline within a few weeks. Besides contemporary traditional biomarkers (CRP, BNP), newer biomarkers, such as galectin-3, TNF-α, and various MiRNAs, can predict inflammatory response and related cardiac injury. Determination of inflammatory markers in the perioperative period could help identify patients at risk for cardiovascular events. The reduction in perioperative inflammatory response may improve surgical outcomes. Prevention and treatment of systemic inflammation can be achieved by optimization of surgical procedures, anesthetic regimen, and pharmacological agents, especially interleukin inhibitors. Determination of inflammatory biomarkers, along with prevention and treatment of inflammation, can improve perioperative cardiac risk reduction strategies.