Towards routine monitoring for myocardial injury after noncardiac surgery

Myocardial injury after noncardiac surgery (MINS) occurs in approximately 13% of adults ≥ 45 years of age who undergo major inpatient noncardiac surgery and is associated with an increased risk of 30-day and 1-year mortality. Routine perioperative troponin monitoring is needed to avoid missing the majority of MINS events. Although there are challenges to the implementation of MINS surveillance, there has been enormous growth in the uptake of MINS monitoring across Canadian centres. In this paper, we explore challenges to routine screening for MINS and strategies to overcome them. The key challenges were stratifying who to monitor, management strategies and outcomes requiring further research, and resource limitations. Several groups have documented high uptake of perioperative troponin monitoring at centres that have established institutional protocols. Strategies to facilitate implementation of the MINS guidelines include multidisciplinary collaboration, standardized clinical pathways, and audit and feedback. Implementation of a routine MINS monitoring program requires concerted multidisciplinary effort throughout the perioperative period, encompassing the preadmission clinic, postoperative wards, and outpatient clinics.