Preoperative evaluation: biomarkers Chapters

It is estimated that over 200 million major surgeries are performed worldwide annually, of which more than 10 million patients will suffer a major cardiac complication. Accurate preoperative cardiac risk estimation is important to allow patients to make informed decisions regarding surgery and to identify patients who require enhanced monitoring after surgery. Physicians primarily use clinical evaluation to assess preoperative cardiac risk, and often clinicians use clinical risk scores. Although such scores have utility, these clinical risk scores often underestimate perioperative cardiac risk. Biomarkers further enhance risk prediction; tests can be performed quickly with limited costs, with results readily available during initial preoperative evaluation. The predictive capabilities of several biomarkers have been studied in non-cardiac surgery. N-terminal pro-brain natriuretic peptide (NT-proBNP) and BNP have the most robust evidence supporting their use to enhance prediction of perioperative major cardiac events.