Eckhard Mauermann1, Christian Puelacher, Giovanna Lurati Buse. 1. aDepartment for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy bDepartment of Cardiology, Basel University Hospital, Basel, Switzerland.
Abstract
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.
Authors: Paymon M Azizi; Duminda N Wijeysundera; Harindra C Wijeysundera; Peter C Austin; Angela Jerath; Lu Han; Maria Koh; Dennis T Ko Journal: CJC Open Date: 2021-03-26
Authors: Laura Verbree-Willemsen; Remco B Grobben; Judith Ar van Waes; Linda M Peelen; Hendrik M Nathoe; Wilton A van Klei; Diederick E Grobbee Journal: Eur J Prev Cardiol Date: 2018-09-12 Impact factor: 7.804