Department of Cardiology, University of Rome Tor Vergata, 00133 Rome, Italy.
Department of Experimental Medicine and CardioLab, University of Rome Tor Vergata, 00133 Rome, Italy.
Int J Environ Res Public Health. 2022 Apr 24;19(9):5182. doi: 10.3390/ijerph19095182.
Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.
接受大手术的患者在围手术期有发生心血管事件的实质性风险。尽管已经基于病史、经典风险因素和非侵入性心脏检查引入了几种风险评分，但预测非心脏手术患者心血管事件的可能性仍然有限。心脏特异性生物标志物，利钠肽（NPs）和心肌肌钙蛋白（cTn）已被提议作为围手术期风险预测的附加工具。这篇综述文章旨在讨论术前水平和围手术期变化的心脏特异性生物标志物在预测大非心脏手术后患者不良结局方面的价值。基于几项前瞻性观察性研究和六项荟萃分析，一些指南建议测量 NPs 以细化非心脏手术患者围手术期心脏风险评估。最近，几项研究报告称，在接受高敏心肌肌钙蛋白 T 和 I 检测的手术患者中，尤其是在老年患者或合并症患者中，死亡率更高。这一证据应在未来关于大非心脏手术后患者围手术期风险评估的国际指南中加以考虑。
