Myocardial injury after non-cardiac surgery: diagnosis and management

被引:107
|
作者
Devereaux, P. J. [1 ,2 ,3 ,4 ]
Szczeklik, Wojciech [5 ]
机构
[1] McMaster Univ, Hamilton Gen Hosp, Dept Hlth Res Methods Evidence & Impact, David Braley Res Bldg,237 Barton St East, Hamilton, ON L8L 2X2, Canada
[2] Hamilton Gen Hosp, Populat Hlth Res Inst, David Braley Res Bldg,237 Barton St East, Hamilton, ON L8L 2X2, Canada
[3] McMaster Univ, Hamilton Gen Hosp, Dept Med, David Braley Res Bldg,237 Barton St East, Hamilton, ON L8L 2X2, Canada
[4] Outcomes Res Consortium, 109 Partridge Lane, Cleveland, OH 44022 USA
[5] Jagiellonian Univ Med Coll, Dept Intens Care & Perioperat Med, Ul Skawinska 8, PL-31066 Krakow, Poland
关键词
Myocardial injury; Myocardial ischaemia; Non-cardiac surgery; Dabigatran; INFARCTION; INTERVENTION; METAANALYSIS; ASSOCIATION; DABIGATRAN; MORTALITY; ASPIRIN; PLAQUE;
D O I
10.1093/eurheartj/ehz301
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Myocardial injury after non-cardiac surgery (MINS) is due to myocardial ischaemia (i.e. supply-demand mismatch or thrombus) and is associated with an increased risk of mortality and major vascular complications at 30 days and up to 2 years after non-cardiac surgery. The diagnostic criteria for MINS includes an elevated post-operative troponin measurement judged as resulting from myocardial ischaemia (i.e. no evidence of a non-ischaemic aetiology), during or within 30 days after non-cardiac surgery, and without the requirement of an ischaemic feature (e.g. ischaemic symptom, ischaemic electrocardiography finding). For patients with MINS who are not at high risk of bleeding, physicians should consider initiating dabigatran 110 mg twice daily and low-dose aspirin. Physicians should also consider initiating statin therapy in patients with MINS. Most MINS patients should only be referred to cardiac catheterization if they demonstrate recurrent instability (e.g. cardiac ischaemia, heart failure). Patients >= 65 years of age or with known atherosclerotic disease should have troponin measurements on days 1, 2, and 3 after surgery while the patient is in hospital to avoid missing >90% of MINS and the opportunity to initiate secondary prophylactic measures and follow-up.
引用
收藏
页码:3083 / 3091
页数:9
相关论文
共 50 条
  • [1] Myocardial injury after non-cardiac surgery
    Kulkarni, Anjali
    Marcucci, Maura
    Nguyen, Julie M. V.
    [J]. CANADIAN MEDICAL ASSOCIATION JOURNAL, 2024, 196 (28) : E981 - E982
  • [2] The aetiology of myocardial injury after non-cardiac surgery
    Grobben, R. B.
    van Klei, W. A.
    Grobbee, D. E.
    Nathoe, H. M.
    [J]. NETHERLANDS HEART JOURNAL, 2013, 21 (09) : 380 - 388
  • [3] The aetiology of myocardial injury after non-cardiac surgery
    R. B. Grobben
    W. A. van Klei
    D. E. Grobbee
    H. M. Nathoe
    [J]. Netherlands Heart Journal, 2013, 21 : 380 - 388
  • [4] The role of routine postoperative troponin measurement in the diagnosis and management of myocardial injury after non-cardiac surgery
    Sharma, V.
    Sessler, D. I.
    Hausenloy, D. J.
    [J]. ANAESTHESIA, 2021, 76 (01) : 11 - 14
  • [5] MINS (Myocardial Injury after Non-Cardiac Surgery)Y
    Bosses, G.
    Friebel, J.
    Ernst, M.
    Klages, J.
    Ruetzler, K.
    Landmesser, U.
    Hommel, M.
    O'Brien, B.
    [J]. ANASTHESIOLOGIE & INTENSIVMEDIZIN, 2022, 63 : 188 - 198
  • [6] Myocardial injury after non-cardiac surgery: a perioperative affair?
    Micciche, Viviana
    Baldi, Cesare
    De Robertis, Edoardo
    Piazza, Ornella
    [J]. MINERVA ANESTESIOLOGICA, 2018, 84 (10) : 1209 - 1218
  • [7] Myocardial Injury after Non-cardiac Surgery - State of the Art
    Lagoeiro Jorge, Antonio Jose
    Mesquita, Evandro Tinoco
    Martins, Wolney de Andrade
    [J]. ARQUIVOS BRASILEIROS DE CARDIOLOGIA, 2021, 117 (03) : 544 - 553
  • [8] Myocardial injury after non-cardiac surgery: a new clinical entity
    Biccard, B. M.
    [J]. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA, 2014, 20 (01) : 24 - 24
  • [9] Myocardial injury after non-cardiac surgery: Time to shed the ignorance
    Coetzee, E.
    Biccard, B. M.
    [J]. SAMJ SOUTH AFRICAN MEDICAL JOURNAL, 2018, 108 (06): : 464 - 467
  • [10] Preoperative hyperglycaemia and risk of myocardial injury after non-cardiac surgery
    Ng, Arnold C. T.
    Bax, Jeroen J.
    [J]. LANCET DIABETES & ENDOCRINOLOGY, 2018, 6 (10): : 757 - 759