Addressing Perioperative Myocardial Ischemia

Abstract

Worldwide, 200 million adults undergo major noncardiac surgery every year, and approximately 8 million of these patients will suffer a myocardial injury after noncardiac surgery (MINS). MINS is defined as a prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The diagnostic criterion for MINS is an elevated troponin measurement resulting from myocardial ischemia. MINS is an independent predictor of 30-day and 1-year mortality. Without troponin monitoring, the majority of MINS events will go undetected because >80 % of patients suffering from MINS do not experience ischemic symptoms. Guideline committees have recently recommended monitoring perioperative troponin measurements in high-risk patients having noncardiac surgery. Risk-adjusted observational data suggest aspirin and a statin can reduce the risk of 30-day mortality in patients who have experienced MINS.