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Updated: Oct 16, 2025
A Murine Closed-chest Model of Myocardial Ischemia and Reperfusion
Published on: July 17, 2012
Myocardial injury in noncardiac surgery
Jungchan Park1, Jong-Hwan Lee1
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Myocardial injury after noncardiac surgery (MINS) increases mortality. Early detection and management, particularly in high-risk patients, are crucial for improving outcomes.
Area of Science:
- Cardiology
- Perioperative Medicine
- Critical Care
Background:
- Myocardial injury, defined by elevated cardiac troponin (cTn), significantly increases postoperative mortality after noncardiac surgery.
- Myocardial injury after noncardiac surgery (MINS) is diagnosed by cTn elevation within 30 days post-surgery, excluding non-ischemic causes.
- Most MINS cases are asymptomatic and stem from oxygen supply-demand mismatch.
Purpose of the Study:
- To review the definition, diagnosis, risk factors, and management of MINS.
- To highlight the importance of early detection and intervention for MINS.
- To discuss current guidelines and future research directions for MINS.
Main Methods:
- Literature review of studies on myocardial injury and noncardiac surgery.
- Analysis of diagnostic criteria and risk factors for MINS.
- Evaluation of therapeutic strategies and their impact on mortality.
Main Results:
- MINS is a significant predictor of postoperative mortality.
- Risk factors include comorbidities, anemia, glucose levels, and intraoperative blood pressure.
- Routine cTn monitoring in high-risk patients is recommended, as MINS often occurs symptomatically within 3 days post-surgery.
Conclusions:
- MINS is a critical concern in noncardiac surgery, necessitating proactive management.
- Cardiovascular medications like aspirin, antihypertensives, statins, and direct oral anticoagulants show benefit in MINS patients.
- Further research is needed to explore modifiable factors for MINS prevention and management.
Abstract:
Myocardial injury is defined as an elevation of cardiac troponin (cTn) levels with or without associated ischemic symptoms. Robust evidence suggests that myocardial injury increases postoperative mortality after noncardiac surgery. The diagnostic criteria for myocardial injury after noncardiac surgery (MINS) include an elevation of cTn levels within 30 d of surgery without evidence of non-ischemic etiology. The majority of cases of MINS do not present with ischemic symptoms and are caused by a mismatch in oxygen supply and demand. Predictive models for general cardiac risk stratification can be considered for MINS. Risk factors include comorbidities, anemia, glucose levels, and intraoperative blood pressure. Modifiable factors may help prevent MINS; however, further studies are needed. Recent guidelines recommend routine monitoring of cTn levels during the first 48 h post-operation in high-risk patients since MINS most often occurs in the first 3 days after surgery without symptoms. The use of cardiovascular drugs, such as aspirin, antihypertensives, and statins, has had beneficial effects in patients with MINS, and direct oral anticoagulants have been shown to reduce the mortality associated with MINS in a randomized controlled trial. Myocardial injury detected before noncardiac surgery was also found to be associated with postoperative mortality, though further studies are needed.
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