Using High-Sensitivity Troponin for Enhancing Risk Prediction after Non-Cardiac Surgery – Are We There Yet?

The homeostatic disruption related to non-cardiac surgery is a well-described trigger for cardiovascular morbidity and mortality in the early and late post-operative periods.^, Through multiple mechanisms, including inflammation and hypercoagulability, hemodynamic instability and blood loss, hypoxemia or suspension of protective therapies, known or silent chronic cardiac conditions like coronary artery disease, left ventricular dysfunction or valve disease may serve as the substrate for myocardial ischemia and infarction, heart failure or arrhythmias.

Epidemiologically, a significant rate of cardiac complications, combined with an immense number of patients undergoing non-cardiac surgical procedures per annum creates a major public healthcare challenge, necessarily shifting the focus towards prevention. Traditionally, risk assessment has been based on patient factors, type of surgery, and urgency of the intervention, which are included, albeit with different weighing, in the available risk scores.^, Unfortunately, the discriminative ability of existing scores is far from optimal, leaving room for complementary tools like biomarkers. Specifically, the bloodstream release of cardiac troponin (cTn), reflecting multifactorial cardiomyocyte injury, has been shown to signal increased morbidity and mortality when elevated in the perioperative period. However, and until now, the integration of this so-called MINS (“myocardial injury after non-cardiac surgery”) with the more familiar clinical risk evaluation in the task of risk prediction remains a question to be properly answered.

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