MINS

Q: Pulmonary embolism (PE), sepsis, or cardioversion are considered the main reasons behind myocardial injury after noncardiac surgery (MINS)? (select one)

A) True
B) False


Answer: B

The main reason behind MINS is usually either underlying coronary artery disease CAD) or an acute thrombus. Perioperative MI due to PE, sepsis or cardioversion during surgery are not even considered as a cause in MINS. The most important thing to remember is that any troponin elevation in non-cardiac surgery implies myocardial injury or ischemia, and underlying CAD should be strongly considered and pursued.

#cardiology


References:

1. Botto F, Alonso-Coello P, Chan MT, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology 2014; 120:564. 

2. Gualandro DM, Campos CA, Calderaro D, et al. Coronary plaque rupture in patients with myocardial infarction after noncardiac surgery: frequent and dangerous. Atherosclerosis 2012; 222:191. 

3. Sheth T, Natarajan MK, Hsieh V, et al. Incidence of thrombosis in perioperative and non-operative myocardial infarction. Br J Anaesth 2018; 120:725. 

4.  Landesberg G, Beattie WS, Mosseri M, et al. Perioperative myocardial infarction. Circulation 2009; 119:2936. 

5. Writing Committee for the VISION Study Investigators, Devereaux PJ, Biccard BM, et al. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA 2017; 317:1642. 

6. Puelacher C, Lurati Buse G, Seeberger D, et al. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization. Circulation 2018; 137:1221.