The silent killer: myocardial injury after non-cardiac surgery (MINS)

Introduction: Recent work into the causes of death after non-cardiac surgery has identified a new clinical concept, namely myocardial injury after non-cardiac surgery (MINS). The pathophysiology is related to a supply-and-demand mismatch in the peri-operative period and differs from the traditional model of myocardial ischaemia and infarction. Methods: Literature review of current body of knowledge and recent large multicentre clinical trials. Results: MINS is associated with increased morbidity and mortality at 30 days’ post-surgery. A large international multicentre trial found that a troponin T level of greater than 0.3 ng/ml was associated with a mortality rate of 16.9%. Moreover, 84.2% of MINS would probably go undetected if systematic troponin monitoring after surgery was not performed. Conclusion: This review examines the current body of knowledge and provides practical guidelines on how to identify and manage patients with MINS. Level of evidence: Level 5