Physicians Should Obtain Perioperative Cardiac Troponin Measurements in At-Risk Patients Undergoing Noncardiac Surgery

Surgery is common; the average American will undergo 7 operations during their lifetime (1). Although surgery has the potential to improve and prolong the quality and duration of life, postoperative death is the third leading cause of death worldwide (2). Approximately half of perioperative deaths are vascular, and myocardial ischemic injuries are the most common cause of perioperative vascular deaths (3). Most perioperative myocardial ischemic injuries are clinically asymptomatic, and without troponin monitoring after noncardiac surgery, these prognostically important complications will go unrecognized (4). Here, we review and comment on the evidence for monitoring perioperative troponin measurements in at-risk patients undergoing noncardiac surgery. In a 1938 publication, Master and colleagues reported a case series of patients who had perioperative myocardial infarctions (MI), and 60% of the patients did not experience ischemic pain (5). The authors stated the lack of ischemic symptoms, “may be accounted for, in part, by the liberal use of narcotics and sedatives after operation” (5). This study, from over 80 years ago, identified the challenge in diagnosing perioperative MI (i.e., most events are asymptomatic).