Postoperative Management

  • Daily troponin for 48-72 hrs postop in pts w/ ↑ NT-proBNP/BNP preop

    • If no preop BNP, measure in at risk patients (>5% risk CVS death or nonfatal MI @ 30 days)

    • Myocardial injury after noncardiac surgery (MINS) = peak troponin T ≥0.03 ng/mL believed to be d/t myocardial ischemia

      • Often asymptomatic

      • a/w ↑ 30 day mortality

 

  • Postop ECG in PACU for same group of pts monitored w/ postop troponin

 

  • Suggest shared-care mgt (ex anesthesiologist, cardiologist, geriatrician, internist) of pts w/ ↑ NT-proBNP/BNP preop and “@ risk” pts

 

  • Initiate long-term ASA & statin tx in pts who suffer myocardial injury/infarction postop

 

 

Adapted from Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Canadian Journal of Cardiology. January 2017, Volume 33, Issue 1, Pages 17–32