MINS (Myocardial Injury after Non-Cardiac Surgery)Y

Myocardial Injury after Noncardiac Surgery (MINS) is defined by a troponin elevation above the 99th percentile of the upper limit after non-cardiac surgery. Non-ischaemic causes for the elevation including pulmonary embolism and sepsis must be excluded. The troponin increase does not necessarily have to be accompanied by other signs of myocardial ischaemia. Up to 5 - 25 % of patients with an elevated baseline cardiovascular risk who underwent major non-cardiac surgery have MINS. In patients with MINS, the overall 30-day mortality was seen to be 8 to 10-times higher (10 % with MINS vs. 1.2 % without MINS) (1-3). The causes of MINS are thought to be the presence of coronary artery disease or a perioperative mismatch of myocardial oxygen supply and demand. A variety of risk factors have been identified for the development of MINS, the main risk factor being the individual atherosclerotic burden. No safe and effective preoperative methods are known to prevent MINS. While perioperative episodes of hypotension are strongly associated with an increased risk of MINS, episodes of tachycardia are likely associated with the development of MINS, but this remains controversial. Postoperatively, only 6 - 7 % of all MINS patients experience ischaemic symptoms and these may be masked by analgesia and sedation. Postoperative troponin screening is essential to identify MINS. Patients with MINS should be referred for specialist cardiological assessment and diagnosis. Since the optimal postoperative treatment of MINS is still unclear, prophylaxis of secondary cardiovascular complications is crucial, especially by improving/intensifying the therapy of pre-existing coronary atherosclerosis. To our knowledge, the concept of MINS has not yet been established in German-speaking health care systems. We therefore recommend a preoperative risk evaluation for patients and a referral of high-risk cases to an interdisciplinary board of cardiologists, surgeons and anaesthetists to define a personalised perioperative strategy for prevention, diagnostics and an adequate therapeutic approach.