7. We recommend measuring NT-proBNP or BNP before noncardiac surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have an RCRI score ≥1(Strong Recommendation; Moderate-Quality Evidence).

Cost and accessibility were considered important determinants of biomarker selection. Considering cost, we restricted testing to patient groups that had a baseline clinical risk estimate > 5%. Data from the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study showed that patients 65 years of age or older or 45-64 years of age with known cardiovascular disease have a baseline risk > 5% for cardiovascular death or nonfatal myocardial infarction at 30 days after surgery, whereas patients without these characteristics have a ≤2.0% 30-day event rate. Compared with cardiac imaging and noninvasive cardiac stress testing, NT-proBNP/BNP biomarkers are inexpensive and avoid the need for return visits.

Hospitals that do not analyze NT-proBNP/BNP in their core laboratory can obtain an instrument to allow clinicians to obtain NT-proBNP as a point of care test in the preoperative setting, offering biomarker information within minutes.