Further Testing - Biomarkers
When the clinical team chooses to perform further cardiac testing to inform decision-making and management when considering non-cardiac surgery, ACC recommends a two-step process starting with biomarker evaluation followed, if abnormal, by structural and/or functional evaluation.
Are results of biomarkers (BNP/pro-BNP, consider hs-cTn) normal or abnormal?
ACC cites that these tests have excellent negative predictive values. ACC also notes that no study thus far has shown that use of these biomarkers in perioperative care improves outcomes, despite being recommended by other organizations since 2016.
BNP or NT-pro-BNP testing carries a 2a recommendation from ACC. Abnormal thresholds are BNP >92 ng/L, NT-pro-BNP ≥300 ng/L.
hs-cTn (hi-sensitivity cardiac troponin) testing carries a 2b recommendation from ACC. Abnormal threshold is cTn >99th percentile upper reference range for the assay.