Perioperative Myocardial Injury
“Preoperative BNP: Epidemiological Patterns, Management Strategies and Cost Analysis of Care”
Recently, the use of preoperative BNP as a preoperative risk stratifcation tool was added to the Canadian Cardiovascular Society (CCS) guidelines (4) on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery, based on the prognostic value of preoperative BNP in indentifiy patients at significant risk of 30-day mortality, nonfatal myocardial infarction, or myocardial injury after noncardiac surgery (MINS). While the value of screening for high risk patients through the use of preoperative BNP been demonstrated, the management of postoperative ischemia is less clear. Therefore, this study aims to: 1. Evaluation of the use of BNP as a preoperative screening biomarker; how often is it ordered in Anesthesia Preadmission Clinic and what is the incidence of a positive result (BNP a?Y 92 ng/L) 2. Determine the incidence of myocardial injury after non-cardiac surgery (MINS) at 30 days and myocardial infarction at 1 year at a tertiary care center when BNP is used as a screening tool 3. Record patterns of management of patients with MINS 4. Determine the cost associated with the different patterns of management of MINS 5. Comparison with a cohort group who qualified for BNP screening according to CCS guidelines but did not have it measured. The investigators will attempt to evaluate the cohort group for MINS at 30 days and myocardial infarction at 1 year.
Cardiac risk stratification using preoperative BNP measurement, followed by postoperative cardiac monitoring
Patients undergoing non-cardiac surgery risk stratified using BNP measurements according to CCS guidelines.
Use of traditional perioperative cardiac risk stratification only
Patients undergoing non-cardiac surgery risk stratified using tools other than BNP measurement such as revised cardiac risk index (RCRI).
Epidemiological Patterns, Management Strategies and Cost Analysis of Care for the Patient With Perioperative Myocardial Injury When BNP is Used as a Screening Tool for Non-Cardiac Surgery