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Published on: June 11, 2020
Myocardial Injury after Non-cardiac Surgery - State of the Art
Antonio José Lagoeiro Jorge1, Evandro Tinoco Mesquita2,3,4,5, Wolney de Andrade Martins1,5
1Universidade Federal Fluminense (UFF), Niterói, RJ - Brasil.
Abstract:
Approximately 300 million non-cardiac surgeries are performed annually worldwide and adverse cardiovascular events are the main cause of morbidity and mortality in the peri- and postoperative period. Myocardial injury after non-cardiac surgery (MINS) is a new clinical entity associated with adverse cardiovascular outcomes. MINS is defined as myocardial injury that can result in necrosis due to ischemia, marked by increase in biomarker levels. It has prognostic relevance and occurs within up to 30 days after non-cardiac surgery. The diagnostic criteria for MINS are an elevated postoperative measure of troponin judged as secondary to myocardial ischemia, i.e., with no evidence of a non-ischemic etiology, during or within 30 days after non-cardiac surgery, and without the requirement of an ischemic symptom or electrocardiographic finding of ischemia. Recently, patients at higher risk for MINS have been recognized using clinical variables and biomarkers and established protocols for greater surveillance in relation to electrocardiographic monitoring and cardiac troponin dosage. Elderly patients with previous atherosclerotic disease need to measure troponin daily in the postoperative period. The aim of the present work is to describe this new public health problem, its clinical impact and contemporary therapeutic approach.
Insights
Myocardial injury after non-cardiac surgery (MINS) is a significant cause of death. Early detection and monitoring of MINS in high-risk patients can improve outcomes.
Area of Science:
- Cardiology
- Perioperative Medicine
- Public Health
Background:
- Adverse cardiovascular events are a leading cause of mortality following approximately 300 million annual non-cardiac surgeries worldwide.
- Myocardial injury after non-cardiac surgery (MINS) is a newly recognized clinical entity with significant prognostic relevance.
- MINS is characterized by myocardial injury due to ischemia, indicated by elevated biomarker levels, occurring within 30 days post-surgery.
Purpose of the Study:
- To describe the public health problem of MINS.
- To outline the clinical impact of MINS.
- To review contemporary therapeutic approaches for MINS.
Main Methods:
- Defining MINS based on elevated postoperative troponin levels secondary to ischemia, without requiring ischemic symptoms or ECG findings.
- Identifying high-risk patients using clinical variables and biomarkers.
- Implementing enhanced surveillance protocols, including ECG monitoring and troponin dosage, particularly daily troponin measurement for elderly patients with atherosclerotic disease.
Main Results:
- MINS is a critical factor in perioperative morbidity and mortality.
- Risk stratification and targeted monitoring protocols are being established for MINS.
- Specific recommendations exist for high-risk populations, such as daily troponin monitoring for elderly patients with atherosclerotic disease.
Conclusions:
- MINS represents a significant, under-recognized perioperative complication.
- Understanding MINS's clinical impact and implementing current therapeutic strategies are crucial.
- Further research and standardized protocols are needed to manage MINS effectively.
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