Myocardial injury in noncardiac surgery

• Published in: Korean journal of anesthesiology Vol. 75; no. 1; pp. 4 - 11
• Main Authors: Park, Jungchan, Lee, Jong-Hwan
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Anesthesiologists 01.02.2022; 대한마취통증의학회
• Subjects: Blood Pressure; Humans; mortality; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; patient outcome assessment; postoperative complications; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative Period; Review; Risk Factors; troponin i; troponin t; 마취과학; Patient outcome assessment; Postoperative period; Troponin I; Mortality; Postoperative complications; Troponin T
• ISSN: 2005-6419; 2005-7563; 2005-7563
• DOI: 10.4097/kja.21372

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.