Recommendation on the use of cardiac biomarkers in the ESC guidelines for the perioperative management of patients undergoing non-cardiac surgery: challenges and opportunities

Perioperative myocardial injury (PMI) is a common complication after non-cardiac surgery and is associated with high postoperative mortality. The current ESC guidelines on the perioperative management of patients undergoing non-cardiac surgery recommend routine perioperative troponin surveillance before medium-and high-risk non-cardiac surgery in patients at an increased risk for perioperative cardiovascular events in order to detect PMI. Measurement of preoperative troponin levels is recommended to differentiate from chronic myocardial injury as the cause of the increase in troponin. As postoperative mortality is significantly elevated in patients with and without additional ischemic symptoms or ECG changes, the diagnosis of PMI is solely based on troponin levels (e.g., high-sensitivity troponin T assay: increase = 14 ng/L), as opposed to the diagnosis of acute myocardial infarction. The causes of PMI are heterogeneous and patients with PMI need a systematic work-up and treatment according to the precise cause. An interdisciplinary approach is mandatory for the successful implementation of PMI screening.