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A Murine Closed-chest Model of Myocardial Ischemia and Reperfusion
Published on: July 17, 2012
Myocardial injury after noncardiac surgery
James Khan1, Pablo Alonso-Coello, P J Devereaux
1aDepartment of Anesthesia, University of Toronto, Toronto bDepartment of Clinical Epidemiology and Biostatistics, McMaster University cPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada dBiomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain eDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
Purpose Of Review:
Recent investigations have substantially improved our understanding of myocardial injury after noncardiac surgery (MINS).
Recent Findings:
MINS is defined as a prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. MINS occurs in 8% of adults undergoing major noncardiac surgery and is diagnosed with an elevated postoperative troponin measurement. MINS is associated with significant morbidity, and approximately 10% of patients experiencing MINS will die within 30 days. There is a dose-graded response in mortality and time to death with increasing levels of postoperative troponin elevations. Most patients (>80%) suffering from MINS will not experience an ischemic symptom. Without troponin monitoring, the majority of MINS events would go undetected. To avoid missing these prognostically relevant events, guidelines now recommend perioperative troponin monitoring in high-risk patients having noncardiac surgery. In patients who suffer MINS, risk-adjusted observational data suggest that aspirin and a statin can reduce the risk of 30-day mortality.
Summary:
Among adults, MINS is the most common cardiovascular complication that occurs after noncardiac surgery. Given that worldwide 200 million adult patients undergo major noncardiac surgery each year, at least 8 million of these patients will suffer MINS making this a substantial public health problem.
Insights
Myocardial injury after noncardiac surgery (MINS) affects 8% of patients, often without symptoms. Early troponin monitoring and treatments like aspirin and statins are crucial for reducing mortality in these high-risk individuals.
Area of Science:
- Cardiology
- Perioperative Medicine
- Public Health
Background:
- Myocardial injury after noncardiac surgery (MINS) is a significant concern.
- Understanding MINS has advanced, highlighting its impact on patient outcomes.
Purpose of the Study:
- To review current understanding of MINS.
- To emphasize the importance of early detection and management.
Main Methods:
- Analysis of recent investigations and clinical data.
- Review of current guidelines for perioperative troponin monitoring.
Main Results:
- MINS is defined as ischemic myocardial injury within 30 days of noncardiac surgery.
- It affects 8% of adults undergoing major noncardiac surgery, often asymptomatically.
- Elevated troponin levels indicate MINS, which is linked to substantial morbidity and 30-day mortality.
- Risk-adjusted data suggest aspirin and statins may reduce 30-day mortality in MINS patients.
Conclusions:
- MINS is the most common cardiovascular complication post-noncardiac surgery.
- With 200 million major noncardiac surgeries annually, MINS affects at least 8 million patients, posing a major public health challenge.
- Perioperative troponin monitoring is recommended for high-risk patients to detect MINS.
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