title: Myocardial injury after noncardiac surgery.
abstract: OBJECTIVE
  Recent investigations have substantially improved our understanding of myocardial injury after noncardiac surgery (MINS).
  
  
  RESULTS
  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 dose-graded 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aDepartment of Anesthesia, University of Toronto, Toronto bDepartment of Clinical Epidemiology and Biostatistics, McMaster University cPopulation Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada dBiomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain eDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Khan
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D002423:Cause of Death; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016343:Monitoring, Intraoperative; D017202:Myocardial Ischemia / Q000209:etiology*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors; D014336:Troponin / Q000032:analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014336:Troponin; D001241:Aspirin