Prevention, epidemiology, and prognosis of perioperative ­myocardial injury

Abstract

SummaryAnnually over 200 million adults undergo noncardiac surgery worldwide.Myocardial ischaemia is a frequent cause of perioperative cardiac morbidity and mortality. Approximately 8 million patients will suffer a myocardial injury after noncardiac surgery (MINS) each year. MINS is defined as a prognostically important myocardial injury due to ischaemia that occurs during, or within 30 days after, noncardiac surgery. The diagnostic criterion for MINS is an elevated troponin measurement resulting from myocardial ischaemia. MINS is a strong, independent predictor of 30-day and 1-year mortality. The majority of patients suffering MINS would go undetected without troponin monitoring since >80% of these patients do not experience ischaemic symptoms. Intensification of pharmacotherapy may reduce 30-day mortality in patients who have experienced MINS. This pape r will review the epidemiology, prevention, prognosis and treatment of MINS.