Perioperative strategies to reduce risk of myocardial injury after non-cardiac surgery (MINS): A narrative review |
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| Affiliation: | 1. Department of Anaesthesiology and Pain Medicine, Inselspital Bern, University Hospital, University of Bern, Switzerland;2. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;3. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;4. Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States of America;5. Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, NY, United States of America;1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA;2. Harvard Medical School, Boston, MA, USA;3. Department of Anesthesia, Brigham & Women''s Hospital, Boston, MA, USA;4. STRATUS Center for Medical Simulation, Brigham & Women''s Hospital, Boston, MA, USA;5. Center for Medical Simulation, Charlestown, MA, USA;1. Division of Management Consulting, Department of Anesthesia, University of Iowa, United States of America;2. Department of Anesthesia, University of Iowa, United States of America;3. Department of Anesthesiology, University of Miami, United States of America;1. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;2. Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, NC, United States of America;3. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America;4. Department of Medicine (Hematology), Oncology, and Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;1. Hospital Clínico Universidad de Chile, Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile;2. St Mary''s Hospital, Department of Anesthesiology, McGill University, Montreal, Quebec, Canada |
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| Abstract: | Myocardial injury is a frequent complication of surgical patients after having non-cardiac surgery that is strongly associated with perioperative mortality. While intraoperative anesthesia-related deaths are exceedingly rare, about 1% of patients undergoing non-cardiac surgery die within the first 30 postoperative days. Given the number of surgeries performed annually, death following surgery is the second leading cause of death in the United States. Myocardial injury after non-cardiac surgery (MINS) is defined as an elevation in troponin concentrations within 30 days postoperatively. Although typically asymptomatic, patients with MINS suffer myocardial damage and have a 10% risk of death within 30 days after surgery and excess risks of mortality that persist during the first postoperative year. Many factors for the development of MINS are non-modifiable, such as preexistent coronary artery disease. Preventive measures, systematic approaches to surveillance and treatment standards are still lacking, however many factors are modifiable and should be considered in clinical practice: the importance of hemodynamic control, adequate oxygen supply, metabolic homeostasis, the use of perioperative medications such as statins, anti-thrombotic agents, beta-blockers, or anti-inflammatory agents, as well as some evidence regarding the choice of sedative and analgesic for anesthesia are discussed. Also, as age and complexity in comorbidities of the surgical patient population increase, there is an urgent need to identify patients at risk for MINS and develop prevention and treatment strategies. In this review, we provide an overview of current screening standards and promising preventive options in the perioperative setting and address knowledge gaps requiring further investigation. |
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