Myocardial Injury After Noncardiac Surgery

Intraoperative cardiovascular management of the patient undergoing noncardiac surgery has become an area of widespread interest given the fact that cardiac death is the leading cause of postoperative death within the first 30 postoperative days. Among patients 45 years of age or older undergoing in-hospital noncardiac surgery, complications of cardiac death, nonfatal myocardial infarction (MI), heart failure, or ventricular tachycardia represent the most common complications and occur in up to 5% of cases. Of these, perioperative MI is the most common. In addition, there is a larger group of patients who have an elevation in troponin (Tn) but no symptoms and no evidence of myocardial ischemia on an electrocardiogram (ECG). These patients are labeled as having myocardial injury after noncardiac surgery (MINS) when there is no evidence of a nonischemic etiology (e.g., venous thromboembolism [VTE], sepsis, atrial fibrillation with rapid ventricular response [RVR]). It is estimated that of the over 200 million annual surgeries performed worldwide, approximately 100 million involve patients over 45 years of age and at risk for MI or myocardial injury. Of these, around 1.1 million suffer a perioperative symptomatic MI, whereas another 2.2 million have asymptomatic MI and 4.6 million have myocardial injury.