CCS Perioperative

• Brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) should be measured before surgery in patients who are ≥65 years of age, are 45 to 64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥1.
• Physician should avoid performing preoperative resting echocardiography, coronary CT angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging.

The 2016 CCS Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery propose a shift of emphasis from reducing preoperative noninvasive cardiac testing to increased use of biomarkers before and after surgery in patients at risk of perioperative cardiac complications. Also recommended is an increased emphasis on postoperative monitoring and management of cardiac complications.