Advances in biomarkers for myocardial injury after non-cardiac surgery

Q: What are the key findings of this study?

Integrating emerging biomarkers like H-FABP, IMA, and cMyC with high-sensitivity cardiac troponin shortens the early diagnostic blind window (<4 hours) and improves MINS risk stratification.

Q: What is the clinical evidence from this study?

Study design: Review. Population: Myocardial injury after non-cardiac surgery (MINS). Intervention: Emerging circulating cardiac biomarkers (e.g., H-FABP, IMA, cMyC, sST2, NT-proBNP, choline, galectin-3, hs-CRP, MPO, copeptin) vs. Conventional cardiac troponin (cTn / hs-cTn) surveillance. Primary outcome: Early detection and prognostic stratification of myocardial injury after non-cardiac surgery (MINS).

Q: What does this research mean for the field?

Integrating emerging biomarkers such as H-FABP, IMA, and cMyC with high-sensitivity cardiac troponin shortens the early diagnostic blind window and improves risk stratification for myocardial injury after non-cardiac surgery. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xinyu Li; Ying Zhu; Ke Peng; Ying Yang; Jing Yan; Yang Zhang; Hong Liu; Xisheng Shan; Fuhai Ji

doi:10.1016/j.jatmed.2026.03.004

March 1, 2026Journal of Anesthesia and Translational MedicineOpen Access

Advances in biomarkers for myocardial injury after non-cardiac surgery

View Full Paper

Ask AI

Bookmark

Share

Key result

Novel biomarkers combined with hs-cTn enhance early detection and risk stratification for MINS within 4 hours.

Figures

Why the study?

Cardiac troponin has limited sensitivity during the early hours after myocardial ischemia, highlighting the need for complementary biomarkers to detect MINS before irreversible necrosis occurs.

Do emerging circulating biomarkers and multi-marker panels improve the early detection and prognostic stratification of myocardial injury after non-cardiac surgery compared to cardiac troponin alone?

Key Points

Summarize emerging circulating biomarkers and multi-marker approaches capable of detecting myocardial injury after non-cardiac surgery before the onset of irreversible myocardial necrosis.
Reviewed the release kinetics, diagnostic performance, and pathophysiological pathways of novel markers (including H-FABP, IMA, cMyC, and copeptin) alongside established standards (cTn, hs-cTn, NT-proBNP).
Assessed diagnostic cutoffs, prognostic implications, and implementation barriers for early postoperative myocardial injury surveillance.
MINS occurs in 13–18% of patients within 30 days after non-cardiac surgery, yet 84–93% of patients remain asymptomatic without typical ischemic manifestations.
Postoperative MINS is associated with significant increases in nonfatal cardiac arrest (risk ratio, 14.58; 95% CI, 5.75–37.02; P < 0.001), congestive heart failure (risk ratio, 10.34; 95% CI, 7.99–13.37; P < 0.001), and stroke (risk ratio, 4.66; 95% CI, 2.87–7.58; P < 0.001).
Novel biomarkers address the early sensitivity window of troponin, with H-FABP detectable within 1 h and IMA showing alterations within minutes of myocardial ischemia.

Structured PICO

Do emerging circulating biomarkers and multi-marker panels improve the early detection and prognostic stratification of myocardial injury after non-cardiac surgery compared to cardiac troponin alone?

P

Population

Patients undergoing non-cardiac surgery monitored with perioperative cardiac biomarkers for myocardial injury within 30 days postoperatively.

E

Exposure

Emerging circulating biomarkers for early MINS detection (including heart-type fatty acid-binding protein [H-FABP], ischemia-modified albumin [IMA], cardiac myosin-binding protein C [cMyC], soluble ST2 [sST2], BNP/NT-proBNP, choline, galectin-3, hs-CRP, myeloperoxidase [MPO], matrix metalloproteinases [MMPs], pregnancy-associated plasma protein-A [PAPP-A], copeptin, and growth differentiation factor-15 [GDF-15]) and multi-marker panels

C

Comparator

Conventional reference-standard biomarker surveillance using cardiac troponin (cTn) or high-sensitivity cardiac troponin (hs-cTn)

O

Outcome

Early detection and diagnosis of myocardial injury after non-cardiac surgery (MINS) and prognostic risk stratification (including 30-day mortality and major adverse cardiovascular events)

Limitations

Many novel biomarkers (such as H-FABP, IMA, hs-CRP, and MPO) have limited myocardial specificity and can be elevated by surgical trauma, systemic inflammation, or renal dysfunction.
Large-scale prospective validation studies are still required to standardize assay-specific thresholds and define the clinical utility of multi-marker panels in perioperative decision-making.
Large-scale prospective studies are required to validate the clinical utility of emerging biomarkers and define their role in perioperative decision-making and guideline development.
Cardiac troponin demonstrates limited sensitivity during the early hours (<4 h) following myocardial ischemia and may be elevated in non-ischemic conditions.
Several novel biomarkers (such as H-FABP, IMA, hs-CRP, and MPO) have lower cardiac specificity and can be elevated in non-cardiac conditions, systemic inflammation, or skeletal muscle injury.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This review highlights that integrating emerging biomarkers (such as H-FABP, IMA, cMyC, and sST2) into multi-marker panels alongside high-sensitivity cardiac troponin has the potential to bridge the early diagnostic blind window and improve prognostic stratification for myocardial injury after non-cardiac surgery.

Abstract

Myocardial injury after non-cardiac surgery (MINS) is a common and clinically important postoperative complication associated with increased short- and long-term mortality. As most cases lack typical ischemic symptoms, diagnosis relies primarily on systematic postoperative biomarker surveillance. Current guidelines recommend serial postoperative measurement of cardiac troponin (cTn) or high-sensitivity cTn, the reference-standard biomarker for myocardial necrosis, in patients at elevated perioperative risk. However, cTn demonstrates limited sensitivity during the early h following myocardial ischemia, underscoring the need for complementary biomarkers capable of detecting ischemic injury before the onset of irreversible myocardial necrosis or troponin elevation. This review summarizes recent advances in emerging circulating biomarkers for early MINS detection, including heart-type fatty acid–binding protein, ischemia-modified albumin, cardiac myosin-binding protein C, copeptin, and other markers reflecting ischemia, necrosis, inflammation, and fibrosis. We critically examine their underlying pathophysiological mechanisms, diagnostic performance, and release kinetics, highlighting their potential to shorten the diagnostic “blind window” associated with conventional biomarkers. The integration of multi-marker panels represents a promising strategy to enhance early diagnostic sensitivity and improve prognostic stratification. Nonetheless, large-scale prospective studies are required to validate their clinical utility and define their role in perioperative decision-making and guideline development.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Li et al. (2026) conducted a review in Myocardial injury after non-cardiac surgery (MINS). Emerging circulating cardiac biomarkers (e.g., H-FABP, IMA, cMyC, sST2, NT-proBNP, choline, galectin-3, hs-CRP, MPO, copeptin) vs. Conventional cardiac troponin (cTn / hs-cTn) surveillance was evaluated on Early detection and prognostic stratification of myocardial injury after non-cardiac surgery (MINS). Integrating emerging biomarkers like H-FABP, IMA, and cMyC with high-sensitivity cardiac troponin shortens the early diagnostic blind window (<4 hours) and improves MINS risk stratification.

synapsesocial.com/papers/69c8c2a4de0f0f753b39cfb9 https://doi.org/10.1016/j.jatmed.2026.03.004

View Full Paper

Ask AI

Bookmark

Share

Advances in biomarkers for myocardial injury after non-cardiac surgery

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Advances in biomarkers for myocardial injury after non-cardiac surgery

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading