Surgery Casualties

The 2007 National Academy of Laboratory Medicine Guideline has suggested the perioperative assay of troponins to detect silent ongoing heart damage or for post-operative risk stratification in high-risk subsets, such as those undergoing vascular surgery, and denied evidence to recommend the routine measurement of brain natriuretic peptide (BNP) and N-terminal fragment of proBNP (NT-proBNP) before or after cardiac surgery (14). Conversely, at least a subset of patients with post-operative negative troponin might show an NP increase due to nonischemic determinants. Because the clinical value of a marker/multimarker strategy should be assessed by its effect on patient management and outcomes, in this instance, diagnostic decision making should consider possible ongoing, life-threatening noncoronary pathologies (e.g., acute decompensated chronic heart failure and pulmonary embolism), with adoption of specific therapeutic options, likely different from those recommended for preventing ischemic events (i.e., continuation of chronic titrated cardioselective beta-blocker, statin, and aspirin treatment).