Methods of detecting atherosclerosis in non-cardiac surgical patients; the role of biochemical markers

• Published in: British journal of anaesthesia : BJA Vol. 97; no. 6; pp. 758 - 769
• Main Authors: Howard-Alpe, G.M., Sear, J.W., Foex, P.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-12-2006; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; atherosclerosis; Biological and medical sciences; biomarkers; Biomarkers - blood; C-reactive protein; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; effects; Humans; Intraoperative Complications; Medical sciences; Myocardial Infarction - etiology; non cardiac cardiovascular system; Perioperative Care - methods; Postoperative Complications; Risk Assessment - methods; surgery; surgery, non cardiac cardiovascular system, effects; Surgical Procedures, Operative; atherosclerosis; surgery, non cardiac cardiovascular system, effects; C-reactive protein; biomarkers; Vascular disease; Human; Surgery; Atherosclerosis; Cardiovascular disease; Anesthesia; effects; biomarkers; atherosclerosis; C-reactive protein; C reactive protein; non cardiac cardiovascular system
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/ael303

Atherosclerosis is a common condition in both the developed and developing world and is now recognised to be an inflammatory condition leading to the development of ischaemic heart disease, cerebrovascular disease and peripheral vascular disease. Ischaemic heart disease is a major risk factor in the pathogenesis of perioperative adverse cardiovascular events which lead to significant morbidity and mortality within the high risk surgical patient population. Current methods of evaluating the likelihood of postoperative cardiovascular complications depend largely on risk scoring systems, and the preoperative assessment of the functional status of the cardiovascular system. However, the possible role of inflammation in the generation of atherosclerosis has led to the identification of several biochemical markers such as acute phase proteins, cellular adhesion molecules and cytokines. An alternative approach therefore is the measurement of preoperative levels of these biomarkers with the aim of assessing pre-existing disease activity.
This review summarises the pathophysiology of atherosclerosis and perioperative myocardial infarction, and discusses the possible future role of biomarkers in the risk stratification of patients undergoing non-cardiac surgery.