title: Chasing myocardial outcomes: perioperative myocardial infarction and cardiac troponin.
abstract: Perioperative myocardial infarction represents the most common cardiovascular complication following non-cardiac surgery, but frequently presents without the usual clinical signs and symptoms consistent with acute coronary syndrome. Given the silent nature of this event, a clinician's reliance on risk stratification tools and cardiac specific biomarkers to assist in the identification of at-risk individuals is heightened in the perioperative setting. Although cardiac troponin elevations following non-cardiac surgery have been consistently linked to increased mortality, uncertainty remains over how to clinically intervene to prevent harm. This decision is further complicated by the increasing sensitivity of the newest generation of cardiac biomarker immunoassays. In this narrative review, the growing body of evidence surrounding cardiac troponin elevations in the perioperative setting, how the evidence has been integrated into recent clinical practice guidelines, and its implications for the detection of perioperative myocardial infarction are discussed.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-4865, USA. Marc.Royo@uphs.upenn.edu.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Royo
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-4865, USA.|Senior Scholar Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014336:Troponin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014336:Troponin