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Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort
Bruce M Biccard1, David Julian Ashbridge Scott2, Matthew T V Chan3
1Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Objective:
To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients.
Background:
MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described.
Methods:
This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring.
Results:
The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4).
Conclusions:
Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.
Insights
Myocardial injury after noncardiac surgery (MINS) affects nearly 1 in 5 vascular surgery patients and significantly increases 30-day mortality. Most MINS cases are silent, highlighting the need for routine troponin monitoring.
Area of Science:
- Cardiology
- Vascular Surgery
- Perioperative Medicine
Background:
- Myocardial injury after noncardiac surgery (MINS) is linked to increased mortality but is poorly understood in vascular surgery.
- Vascular surgery patients represent a unique population with potentially different MINS characteristics and outcomes.
Purpose of the Study:
- To investigate the prognostic significance of MINS in vascular surgery patients.
- To describe the clinical features and 30-day outcomes of vascular surgery patients with and without MINS.
- To quantify the proportion of MINS cases that are asymptomatic and would be missed without routine troponin monitoring.
Main Methods:
- An international prospective cohort study involving 15,102 noncardiac surgery patients, including 502 undergoing vascular surgery.
- Fourth-generation plasma troponin T (TnT) was measured postoperatively; MINS was defined as TnT ≥ 0.03 ng/mL secondary to ischemia.
- Analysis focused on MINS incidence, 30-day mortality, clinical characteristics, and the proportion of undetected MINS.
Main Results:
- The incidence of MINS in vascular surgery patients was 19.1%.
- 30-day mortality was significantly higher in patients with MINS (12.5%) compared to those without (1.5%) (P < 0.001).
- MINS was an independent predictor of 30-day mortality (OR, 9.48). Notably, 74.1% of MINS cases were asymptomatic.
Conclusions:
- MINS is common and prognostically significant in vascular surgery patients, independently associated with increased 30-day mortality.
- The majority of MINS events in this population are silent, underscoring the critical role of routine postoperative troponin monitoring for early detection and management.
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