Biomarkers to Personalize Preoperative Cardiovascular Risk Stratification: Ready for Prime Time?
Authors: Arman Qamar, Sripal Bangalore
Journal: Annals of Internal Medicine (2019)

Editorials21 January 2020Biomarkers to Personalize Preoperative Cardiovascular Risk Stratification: Ready for Prime Time?Arman Qamar, MD, MPH and Sripal Bangalore, MD, MHAArman Qamar, MD, MPHNew York University Grossman School of Medicine, New York, New York (A.Q., S.B.) and Sripal Bangalore, MD, MHANew York University Grossman School of Medicine, New York, New York (A.Q., S.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3718 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Globally, more than 200 million adults have major noncardiac surgery each year (1). Although advances in anesthesia, surgical techniques, and postoperative care have improved outcomes, cardiovascular complications remain the most common causes of postoperative morbidity and mortality. Among patients having elective noncardiac surgery, greater than 5% have a major cardiac complication within the first 30 days, resulting in death, disability, prolonged hospitalization, and increased health care expenditure (2). Several preoperative factors are associated with more cardiac events, including high-risk coronary artery disease, recent stroke, congestive heart failure, renal insufficiency, uncontrolled hypertension, valvular heart disease, and diabetes mellitus. In addition, the ...References1. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373:2258-69. [PMID: 26630144] doi:10.1056/NEJMra1502824 CrossrefMedlineGoogle Scholar2. Kristensen SD, Knuuti J, Saraste A, et al; Authors/Task Force Members. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383-431. [PMID: 25086026] doi:10.1093/eurheartj/ehu282 CrossrefMedlineGoogle Scholar3. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215-45. [PMID: 25085962] doi:10.1161/CIR.0000000000000105 CrossrefMedlineGoogle Scholar4. Clerico A, Emdin M, Passino C. Cardiac biomarkers and risk assessment in patients undergoing major non-cardiac surgery: time to revise the guidelines? Clin Chem Lab Med. 2014;52:959-63. [PMID: 24501160] doi:10.1515/cclm-2013-0900 CrossrefMedlineGoogle Scholar5. Duceppe E, Patel A, Chan MTV, et al. Preoperative N-terminal pro–B-type natriuretic peptide and cardiovascular events after noncardiac surgery. A cohort study. Ann Intern Med. 24 December 2019. [Epub ahead of print]. doi:10.7326/M19-2501 LinkGoogle Scholar6. Karthikeyan G, Moncur RA, Levine O, et al. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies. J Am Coll Cardiol. 2009;54:1599-606. [PMID: 19833258] doi:10.1016/j.jacc.2009.06.028 CrossrefMedlineGoogle Scholar7. Rodseth RN, Biccard BM, Le Manach Y, et al. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis. J Am Coll Cardiol. 2014;63:170-80. [PMID: 24076282] doi:10.1016/j.jacc.2013.08.1630 CrossrefMedlineGoogle Scholar8. Kragelund C, Grønning B, Køber L, et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med. 2005;352:666-75. [PMID: 15716560] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: New York University Grossman School of Medicine, New York, New York (A.Q., S.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3718.Corresponding Author: Sripal Bangalore, MD, MHA, New York University Grossman School of Medicine, 550 First Avenue, SKI9R/109, New York, NY 10016; e-mail, [email protected]com.Current Author Addresses: Drs. Qamar and Bangalore: New York University Grossman School of Medicine, 550 First Avenue, SKI9R/109, New York, NY 10016.This article was published at Annals.org on 24 December 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPreoperative N-Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery Emmanuelle Duceppe , Ameen Patel , Matthew T.V. Chan , Otavio Berwanger , Gareth Ackland , Peter A. Kavsak , Reitze Rodseth , Bruce Biccard , Clara K. Chow , Flavia K. Borges , Gordon Guyatt , Rupert Pearse , Daniel I. Sessler , Diane Heels-Ansdell , Andrea Kurz , Chew Yin Wang , Wojciech Szczeklik , Sadeesh Srinathan , Amit X. Garg , Shirley Pettit , Erin N. Sloan , James L. Januzzi Jr. , Matthew McQueen , Giovanna Lurati Buse , Nicholas L. Mills , Lin Zhang , Robert Sapsford , Guillaume Paré , Michael Walsh , Richard Whitlock , Andre Lamy , Stephen Hill , Lehana Thabane , Salim Yusuf , and P.J. Devereaux Metrics 21 January 2020Volume 172, Issue 2Page: 149-150KeywordsCardiac surgeryHeart diseasesHeart failureMedical risk factorsMyocardial infarctionN terminal pro brain natriuretic peptidesRisk assessmentsSurgeryTreatment guidelinesVascular surgery ePublished: 24 December 2019 Issue Published: 21 January 2020 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...