Major adverse cardiac events are common causes of perioperative mortality and major morbidity. Preventing these complications requires thorough preoperative risk assessment and postoperative monitoring of at-risk patients. Major guidelines recommend assessment based on a validated risk calculator that incorporates patient- and procedure-specific factors. American and European guidelines define when stress testing is needed on the basis of functional capacity assessment. Favoring cost-effectiveness, Canadian guidelines instead recommend obtaining brain natriuretic peptide or N-terminal prohormone of brain natriuretic peptide levels to guide postoperative screening for myocardial injury or infarction. When conditions such as acute coronary syndrome, severe pulmonary hypertension, and decompensated heart failure are identified, nonemergent surgery should be postponed until the condition is appropriately managed. There is an evolving role of biomarkers and myocardial injury after noncardiac surgery to enhance risk stratification, but the effect of interventions guided by these strategies is unclear.

中文翻译：

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术前心脏风险评估。

严重的不良心脏事件是围手术期死亡和高发病率的常见原因。预防这些并发症需要对危险患者进行全面的术前风险评估和术后监测。主要准则建议根据经过验证的风险计算器进行评估，该计算器应结合患者和手术的特定因素。美国和欧洲准则根据功能能力评估定义何时需要进行压力测试。为了提高成本效益，加拿大指南建议获取脑钠肽或脑钠肽水平的N端激素，以指导术后心肌损伤或梗死的筛查。当发现急性冠状动脉综合征，严重肺动脉高压和代偿性心力衰竭等疾病时，不合并手术应推迟到病情得到适当处理之前。非心脏手术后，生物标志物和心肌损伤的作用不断增强，以增强风险分层，但这些策略指导的干预措施的效果尚不清楚。