February 19, 2014Open Access
Myocardial Injury after Noncardiac Surgery
Key Result
Myocardial injury after noncardiac surgery (MINS) occurred in 8.0% of patients and independently predicted 30-day mortality (adjusted HR 3.87; 95% CI 2.96-5.08).
Study Design
Type
Cohort (n=15,065)
Multicenter
Yes
Structured PICO
Does myocardial injury after noncardiac surgery (MINS) predict 30-day mortality in adults aged 45 years or older undergoing in-patient noncardiac surgery?
P
Population
15,065 patients aged 45 years or older undergoing in-patient noncardiac surgery, followed for 30 days to assess the impact of myocardial injury.
E
Exposure
Myocardial injury after noncardiac surgery (MINS), defined as peak troponin T level ≥0.03 ng/ml judged due to myocardial ischemia.
C
Comparator
Patients without MINS.
O
Outcome
30-day mortality.hard clinical
MINS is a common complication (8.0%) after noncardiac surgery that often lacks ischemic symptoms but strongly predicts 30-day mortality.
Main Result
Hazard Ratio: 3.87 (95% CI 2.96–5.08)
Abstract
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. METHODS: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. RESULTS: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. CONCLUSION: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.