This review discusses perioperative cardiac troponin testing for patients undergoing elective non-cardiac surgery (NCS). Myocardial injury (MIj) may occur in approximately 18% of patients undergoing NCS, where it is associated with an increased risk of cardiovascular (CV) events and mortality. However, perioperative MIj is under-diagnosed as it often occurs without ischaemic signs and symptoms, therefore the opportunity to optimise management is missed. Systematic high-sensitivity cardiac troponin (hs-cTn) testing accurately detects MIj and enhances risk stratification. Preoperative hs-cTn testing is recommended for NCS patients with known CV risk factors, including age >65 years, with postoperative hs-cTn surveillance at 24 hours and 48 hours. Identifying the cause of MIj determines the most appropriate treatment.
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