By Dr Jonathan Shurlock
Edited by Dr Saadia Aslam
Perioperative myocardial infarction is associated with increased mortality. The 2022 ESC guidelines have made a class I recommendation for routine postoperative troponin surveillance in select groups of patients (known cardiovascular disease/risk factors) undergoing intermediate- to high-risk surgery. Professor van Klei and his team’s work, published in the European Heart Journal, explores this further whilst highlighting areas whereby routine postoperative troponin surveillance does not meet the WHO criteria for a population screening programme in the graphical abstract below.
The primary areas of contention are the lack of understanding of the natural course of a raised troponin post-surgery, including conflicting views on postoperative myocardial injury. Additionally, a lack of clear diagnostic and management pathways in the context of raised troponin post-operatively, given that observational evidence suggests most peri-procedural MIs are asymptomatic.
Until there is an improved understanding of the various injury pathways, subsequent evidence-based investigation and treatment, it is difficult to change clinical practice to include routine postoperative troponin surveillance without increasing the number of investigations including invasive procedures, without clear benefit to patients.
See the full article for the authors more detailed approach to this contentious area: https://doi.org/10.1093/eurheartj/ehad487
