Myocardial injury after non-cardiac surgery: Diagnosis, prognosis, and management in the critical care setting

Myocardial injury after non-cardiac surgery (MINS) is a common but underrecognized complication whose consequences frequently unfold in the postoperative intensive care or high-dependency setting, where high-risk surgical patients are monitored.The objective of this structured narrative evidence review was to synthesize current evidence on the definition, epidemiology, mechanisms, diagnosis, prognosis, prevention and management of MINS in adults undergoing non-cardiac surgery, with sustained attention to the critical care dimension, and to classify the design of the evidence supporting every management option.PubMed/MEDLINE, Embase and the Cochrane Library were searched for English-language articles published between January 2008 and January 2026; randomized controlled trials, systematic reviews and meta-analyses, large prospective cohorts and current society guidance were prioritized, and case reports and non-peer-reviewed material were excluded.Records were screened in duplicate.No formal risk-of-bias instrument, no certainty-of-evidence framework such as Grading of Recommendations Assessment, Development and Evaluation and no quantitative synthesis were applied; each clinical statement was instead assigned to one of four prespecified design-based evidence tiers.MINS is defined as an ischemic elevation in cardiac troponin within 30 days of non-cardiac surgery that is not explained by a non-ischemic cause.Pooled data from 169 studies and more than 530000 operations place the incidence at 17.9% (95%CI: 16.2%-19.6%),with 30-day mortality of 8.5% (95%CI: 6.2%-11.0%) in patients with MINS compared with 1.2% (95%CI: 0.9%-1.6%) in those without.Most cases are asymptomatic and arise from oxygen supply-demand mismatch.The 2022 European Society of Cardiology, 2017 Canadian Cardiovascular Society and 2024 American Heart Association/American College of Cardiology recommendations are compared directly: they agree on prognostic importance and diverge principally on patient selection.Randomized trials of blood-pressure targets, heart-rate lowering, anti-inflammatory therapy and 4 / 127 aggressive warming have not reduced the incidence of MINS, and no randomized trial has shown that a surveillance-and-response pathway improves patient-important outcomes.The algorithms proposed here are author-derived, evidence-informed frameworks intended for local adaptation and prospective evaluation, not validated standards of care.The principal limitations of this review are its non-systematic search, the absence of formal appraisal, and the substantial assay and definitional heterogeneity of the underlying literature.