Postoperative Troponin Screening: A Cardiac Cassandra?
The cardiovascular management of the patient undergoing non-cardiac surgery has been in evolution for the last 35 years. Over this time frame, two secular trends have advanced in parallel but provided contrary practice implications for the care of the surgical patient. First, cardiovascular event rates have been dropping significantly over time. In 1977, Goldman and colleagues created a risk evaluation system that predicted a 22% rate of "life-threatening" cardiovascular events and more than 50% mortality in the highest risk group1 in 1001 patients undergoing surgery. These rates of events have dropped each decade since significantly. Finks and colleagues reported 2 years ago a mere 2.8% national mortality rate for open abdominal aortic aneurysm repair; the exemplar of routine, high-risk surgery2. These numbers were recapitulated world-wide for high-risk patients undergoing noncardiac surgery in the PeriOperative ISchemic Evaluation (POISE) trial3. Improvements in surgical and anesthetic techniques, perioperative medical therapy, and intensive care have each participated in the significant improvement in outcomes.
- Received May 7, 2013.
- Accepted May 8, 2013.