Recommended measurements to assess and detect the risk of post-operative cardiac complications.

ECG, electrocardiogram; hs-cTn, high-sensitivity cardiac troponin; PMI, peri-operative myocardial infarction/injury; ULN, upper limit of normal. In patients scheduled to undergo intermediate- or high-risk surgery, pre-operative risk assessment is complemented by ECG, hs-cTn, and BNP/NT-proBNP. An absolute increase in hs-cTn concentration of more than the ULN on days 1 or 2 after surgery compared to the pre-operative level is defined as PMI.^109–111 In the absence of a pre-operative hs-cTn T/I concentration, a very high hs-cTn T/I concentration on day 1 (e.g. more than five-times the ULN) or a relevant change from day 1 to day 2 (absolute increase or decrease more than the ULN vs. day 1) would also achieve a reliable diagnosis of PMI. Detection of PMI should trigger ECG recording and detailed clinical evaluation for PMI work-up and therapy. The differential diagnosis of PMI according to the fourth universal definition of MI is discussed in Section 8. The ESC 0/1/2 h algorithm has not been validated for the peri-operative setting and cannot be used here.