Association Between Cardiovascular-Kidney-Metabolic Syndrome and Myocardial Injury After Noncardiac Surgery

Q: What are the key findings of this study?

Advanced cardiovascular-kidney-metabolic syndrome stage 4 independently predicted an increased risk of myocardial injury after noncardiac surgery compared to stage 0 (OR 2.16).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Undergoing noncardiac surgery (n=25040). Intervention: Cardiovascular-kidney-metabolic (CKM) syndrome stage 4 vs. CKM stage 0 (no CKM risk factors). Primary outcome: Myocardial injury after noncardiac surgery (MINS) within 30 days (OR 2.16, 95% CI 1.75-2.66, p=<0.001).

Q: What does this research mean for the field?

Advanced stages of cardiovascular-kidney-metabolic syndrome (CKM) independently predict an increased risk of myocardial injury after noncardiac surgery (MINS). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between cardiovascular-kidney-metabolic (CKM) syndrome staging and the risk of myocardial injury after noncardiac surgery (MINS).

Guosong Liao; Kai Zhang; Jiaxuan Peng; Chang Liu; Bingbing Meng; Siyi Yao; Zhao Li; J Lou; Yanhong Liu; Jiangbei Cao; Weidong Mi; Hao Li; Qiang Fu

doi:10.1016/j.jacasi.2026.01.023

March 1, 2026JACC AsiaOpen Access

Association Between Cardiovascular-Kidney-Metabolic Syndrome and Myocardial Injury After Noncardiac Surgery

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Key result

Stage 4 CKM syndrome linked to ~2.2-fold higher risk of MINS vs. stage 0.

OR 2.16
95% CI 1.75-2.66
P<0.001
n=25,040

Figures

Graphical abstract published by JACC Asia — Graphical abstract · Published by JACC Asia · CC BY

Why the study?

The relationship between cardiovascular-kidney-metabolic syndrome staging and myocardial injury after noncardiac surgery has not been comprehensively studied.

Does advanced Cardiovascular-Kidney-Metabolic (CKM) syndrome stage independently predict an increased risk of myocardial injury after noncardiac surgery (MINS) in patients aged ≥45 years?

Key Points

To evaluate the association between cardiovascular-kidney-metabolic (CKM) syndrome staging and the risk of myocardial injury after noncardiac surgery (MINS).
Single-center retrospective cohort study evaluating 25,040 patients aged ≥45 years who underwent noncardiac surgery between January 2019 and December 2023.
Patients were classified into CKM stages 0 to 4, with MINS defined as postoperative ischemic troponin elevation occurring within 30 days.
Associations were analyzed using four progressive multivariable logistic regression models and subgroup analyses stratified by age, sex, and surgery type.
MINS occurred in 1,782 of 25,040 patients (7.12% [95% CI: 6.80%-7.44%]) at a median of 2.0 days (IQR: 0.8-6.6), displaying a J-shaped incidence across CKM stages 0 to 4 (5.11%, 3.76%, 5.36%, 10.96%, and 15.53%).
In the fully adjusted model with stage 0 as reference, stage 3 (OR: 1.95 [95% CI: 1.60-2.37]; P < 0.001) and stage 4 (OR: 2.16 [95% CI: 1.75-2.66]; P < 0.001) independently predicted increased MINS risk.
A significant interaction with age was detected (P = 0.013), indicating stronger associations between advanced CKM stages and MINS risk in younger patients.

Study Design

Type

Cohort (n=25,040)

Multicenter

No

Structured PICO

Does advanced Cardiovascular-Kidney-Metabolic (CKM) syndrome stage independently predict an increased risk of myocardial injury after noncardiac surgery (MINS) in patients aged ≥45 years?

P

Population

25,040 patients aged ≥45 years undergoing noncardiac surgery under general anesthesia evaluated for preoperative cardiovascular-kidney-metabolic syndrome staging and followed for 30-day outcomes.

E

Exposure

Classification into advanced Cardiovascular-Kidney-Metabolic (CKM) syndrome stages (Stages 1 to 4) according to the American Heart Association 2023 consensus statement

C

Comparator

CKM Stage 0 (no CKM risk factors, BMI <23 kg/m2, no metabolic risk factors, no chronic kidney disease or CVD)

O

Outcome

Myocardial injury after noncardiac surgery (MINS), defined as postoperative high-sensitivity troponin T elevation with presumed ischemic etiology within 30 dayshard clinical

Main Result

Odds Ratio: 2.16 (95% CI 1.75–2.66)

Absolute Event Rate: 15.53% vs 5.11%

p-value: p=<0.001

Limitations

Retrospective, single-center design may limit generalizability
Substantial exclusions owing to missing data introduced potential selection bias
Absence of waist circumference measurements may have resulted in stage 1 underclassification
Reliance on routine clinical data rather than specialized cardiac imaging or biomarker assessments

Implication

Advanced Cardiovascular-Kidney-Metabolic (CKM) syndrome (stages 3 and 4) is an independent predictor of myocardial injury after noncardiac surgery (MINS), demonstrating a J-shaped perioperative risk relationship.

Abstract

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interplay among obesity, metabolic dysfunction, kidney disease, and cardiovascular disease. The relationship between CKM staging and myocardial injury after noncardiac surgery (MINS) has not been comprehensively studied. OBJECTIVES: This study sought to investigate the association between the CKM syndrome and MINS risk in patients undergoing noncardiac surgery. METHODS: This single-center retrospective cohort study included 25,040 patients aged ≥45 years who underwent noncardiac surgery between January 2019 and December 2023. Patients were classified according to CKM stages 0 to 4. MINS was defined as postoperative troponin elevation with ischemic etiology within 30 days. Four progressive multivariable logistic regression models were constructed, and subgroup analyses were performed stratified by age, sex, and surgery type. RESULTS: Among 25,040 patients (median time to MINS: 2.0 days [IQR: 0.8-6.6]), CKM stages 0 to 4 comprised 13.0%, 15.0%, 43.7%, 18.7%, and 9.7%, respectively. MINS occurred in 1,782 patients (7.12% [6.80-7.44]), demonstrating a J-shaped distribution: lowest in stage 1 at 141 of 3,754 (3.76% [3.19-4.41]), intermediate in stages 0 (166 of 3,246, 5.11% [4.40-5.93]) and 2 (586 of 10,943, 5.36% [4.94-5.80]), and highest in stages 3 (512 of 4,670, 10.96% [10.09-11.90]) and 4 (377 of 2,427, 15.53% [14.14-17.04]). With stage 0 as reference, stages 3 (OR: 1.95 [1.60-2.37]) and 4 (OR: 2.16 [1.75-2.66]) independently predicted increased MINS risk (both P < 0.001), with significant age interaction (P = 0.013) showing stronger associations in younger patients. CONCLUSIONS: Advanced CKM stages independently predicted an increased risk of MINS. These findings may improve perioperative risk assessment and guide preventive strategies.

Discussion

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Cite This Study

Liao et al. (2026) conducted a cohort in Undergoing noncardiac surgery (n=25,040). Cardiovascular-kidney-metabolic (CKM) syndrome stage 4 vs. CKM stage 0 (no CKM risk factors) was evaluated on Myocardial injury after noncardiac surgery (MINS) within 30 days (OR 2.16, 95% CI 1.75-2.66, p=<0.001). Advanced cardiovascular-kidney-metabolic syndrome stage 4 independently predicted an increased risk of myocardial injury after noncardiac surgery compared to stage 0 (OR 2.16).

synapsesocial.com/papers/69b8ef12deb47d591b8c5177 https://doi.org/10.1016/j.jacasi.2026.01.023

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Association Between Cardiovascular-Kidney-Metabolic Syndrome and Myocardial Injury After Noncardiac Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association Between Cardiovascular-Kidney-Metabolic Syndrome and Myocardial Injury After Noncardiac Surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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