Italian 
English Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
AUTORI
1Scuola Superiore Sant’Anna e Fondazione CNR – Regione Toscana G. Monasterio, Pisa 2 Dipartimento di Medicina di Laboratorio, Università-Ospedale di Padova
2 Azienda Ospedaliera Universitaria di Padova, e Dipartimento di Medicina, Università di Padova
3 Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata, Roma 4 Dipartimento di Medicina di Laboratorio-DIMED, Università di Padova
4 Ospedale dell’Angelo, Mestre
5 Laboratorio Bianalisi, Carate Brianza (MB)
6 Dipartimento di Medicina di Laboratorio e Anatomia Patologica, Azienda Ospedaliera Universitaria e USL di Modena
7 Laboratorio Analisi, Azienda Ospedaliera-Universitaria di Pisa
8 Medicina di Laboratorio, AOU Ospedali Riuniti Ancona
9 Patologia Clinica P.O. Barone Lombardo, Canicattì, Agrigento
10 U.O. Patologia Clinica, P.O. Santa Maria Novella, Galatina, Lecce
ABSTRACT
Evaluation of the cardiovascular risk in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers
Cardiovascular risk evaluation in patients undergoing major non-cardiac surgery: role of cardiac-specific biomarkers.
Joint document of the Italian Societies of Clinical Biochemistry: European Ligand Assay Society, Sezione Italiana (ELAS), Società Italiana di Biochimica Clinica e Biologia Molecolare Clinica (SIBioC), Società Italiana di Patologia Clinica e Medicina di Laboratorio (SIPMeL) 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 to predict 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 peri-operative period. This Consensus Document 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 6 meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing noncardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cTnT and cTnI, 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 noncardiac surgery.