Update in Perioperative Ischemic Workup: Integrating 2024 AHA/ACC Guidelines and Contemporary Evidence

Area of Science:

• Cardiology
• Anesthesiology
• Internal Medicine

Background:

• Perioperative myocardial ischemia and myocardial injury after noncardiac surgery (MINS) significantly contribute to patient morbidity and mortality.
• Updated guidelines and high-sensitivity biomarkers have changed the approach to preoperative ischemic evaluation.

Purpose of the Study:

• To synthesize current evidence and guidelines for perioperative ischemic evaluation.
• To provide a framework for a risk-based perioperative workup.

Main Methods:

• A narrative review of current literature and major society guidelines.
• Focus on risk stratification, functional capacity, biomarkers, diagnostic tests, and medical optimization.

Main Results:

• A stepwise, risk-based approach using clinical indices, functional capacity, and selective testing is favored.
• Biomarkers (natriuretic peptides, troponins) improve risk prediction and MINS detection.
• Routine preoperative stress testing or revascularization in stable patients is not supported.

Conclusions:

• Modern perioperative evaluation emphasizes individualized, evidence-based assessment over routine testing.
• Integrating biomarkers, risk assessment, and multidisciplinary care may improve outcomes.
• Further research is needed for optimal MINS detection and treatment strategies.