Myocardial injury after noncardiac surgery
Por:
Khan, J, Alonso-Coello, P, Devereaux, PJ
Publicada:
1 jul 2014
Resumen:
Purpose of review
Recent investigations have substantially improved our understanding of myocardial injury after noncardiac surgery (MINS).
Recent findings
MINS is defined as a prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. MINS occurs in 8% of adults undergoing major noncardiac surgery and is diagnosed with an elevated postoperative troponin measurement. MINS is associated with significant morbidity, and approximately 10% of patients experiencing MINS will die within 30 days. There is a dosegraded response in mortality and time to death with increasing levels of postoperative troponin elevations. Most patients (>80%) suffering from MINS will not experience an ischemic symptom. Without troponin monitoring, the majority of MINS events would go undetected. To avoid missing these prognostically relevant events, guidelines now recommend perioperative troponin monitoring in high-risk patients having noncardiac surgery. In patients who suffer MINS, risk-adjusted observational data suggest that aspirin and a statin can reduce the risk of 30-day mortality.
Summary
Among adults, MINS is the most common cardiovascular complication that occurs after noncardiac surgery. Given that worldwide 200 million adult patients undergo major noncardiac surgery each year, at least 8 million of these patients will suffer MINS making this a substantial public health problem.
Filiaciones:
Khan, J:
Univ Toronto, Dept Anesthesia, Toronto, ON, Canada
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Hamilton, ON L8L 2X2, Canada
Alonso-Coello, P:
Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Devereaux, PJ:
McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8L 2X2, Canada
Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada
McMaster Univ, Hamilton, ON L8L 2X2, Canada
McMaster Univ, Dept Med, Hamilton, ON L8L 2X2, Canada
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