What is your approach to checking preoperative cardiac biomarkers such as troponin and BNP?

While now recommended as a means of risk stratification for those over 65 years with cardiac risk factors across all three guidelines (AHA/ACC, CCS, ESC), we mostly reserve the use of biomarkers preoperatively for patients in whom we are on the fence for obtaining additional cardiac workup. We view ...

BNP can be helpful to predict operative risk and decide if further cardiac testing is needed in a higher-risk patient who is not ambulatory. It is most helpful when it is negative. For some patients needing urgent surgery, cardiac testing can delay the procedure and is detrimental. An elevated BNP c...

Beyond numerical risk prediction as a purely statistical matter, it may be useful to consider what these markers actually reflect or represent, and that they have only an incomplete "Venn" overlap.

BNP and proBNP, with exceptions and limitations, reflect a compensation attempt at the physiologic lev...