Myocardial injury after noncardiac surgery: an underappreciated problem and current challenges

To review myocardial injury after noncardiac surgery (MINS), focusing on recent studies, including data on high-sensitivity troponin, which is likely to alter our understanding of MINS.

MINS is greatly underappreciated by clinicians, possibly because of its silent presentation. However, MINS is both common and clinically important. In total, 8% of at-risk patients will suffer a MINS, an event that is associated with death within 30 days with an odds ratio of 3.87 (95% CI 2.96-5.08). Most patients suffering MINS do not fulfill the criteria for perioperative myocardial infarction as they are asymptomatic. Consequently, postoperative troponin measurement is imperative for MINS detection. Evidence from randomized trials on how to prevent or how to treat MINS is still lacking.

Currently, we are limited to appreciating the vast extent of the MINS problem and applying recommendations based on observational data or derived from the nonoperative setting. Routine troponin measurements after noncardiac surgery and the increasing use of high-sensitivity troponins have revealed the larger underwater iceberg of perioperative myocardial injury and ischemia. Clinicians should be sensitized for this important complication and search for it using a perioperative troponin screening.