Improved peri-operative risk stratification in non-cardiac surgery: going beyond established clinical scores

Abstract

This editorial refers to ‘Incremental value of high sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery’[†][1], by M. Weber et al. , on page 853 Risk stratification represents an important clinical strategy to assess the patient's prognosis precisely in various settings and/or tailor therapeutic interventions to his or her specific needs. Initially this was done by clinical judgement based on the patient's history, a physical examination, and measuring select parameters from the clinical chemistry profile. In cardiovascular medicine, nowadays, there are a number of established scores available that measure the patient's absolute risk for various cardiovascular endpoints based on traditional risk factors in primary prevention. Yet, despite the introduction of global risk assessment, e.g. by the European Society of Cardiology (ESC) SCORE,1 prediction of cardiovascular events is limited. This has prompted the search for novel markers to improve risk prediction in apparently healthy subjects. Similarly, in patients with manifest cardiovascular diseases (CVDs), in particular after an acute coronary syndrome (ACS), risk stratification is an important issue. For this purpose, several scores are available: the TIMI (Thrombolysis in Myocardial Infarction)2 and the GRACE (Global Registry of Acute Coronary Events) Score3 which contain a number of clinical variables and information on renal function, blood glucose control, and cardiac enzymes. Based on such variables, fairly reliable prediction not only in the short term but even over a 5-year period can be made.4 In addition, other variables have been proven useful, such as global left ventricular … [1]: #fn-2