https://idwiki.org/index.php?action=history&feed=atom&title=Myocardial_infarction_after_noncardiac_surgery 2026-05-13T00:34:57Z Revision history for this page on the wiki MediaWiki 1.43.8 https://idwiki.org/index.php?title=Myocardial_infarction_after_noncardiac_surgery&diff=7841&oldid=prev 2021-05-07T16:10:14Z

<p>Created page with &quot;== Background == * MINS is the most common cardiovascular complication after noncardiac surgery, with incidence of about 18% * MINS refers to an acute elevation of troponin d...&quot;</p> <p><b>New page</b></p><div>== Background ==<br /> <br /> * MINS is the most common cardiovascular complication after noncardiac surgery, with incidence of about 18%<br /> * MINS refers to an acute elevation of troponin due to myocardial ischemia occuring during or within 30 days of noncardiac surgery<br /> <br /> == Clinical Presentation ==<br /> <br /> * Elevated troponin within 30 days of non-cardiac surgery<br /> * Can be asymptomatic (about 90% of cases), but also includes traditional [[acute coronary syndrome]]<br /> <br /> === Prognosis and Complications ===<br /> <br /> * Increased in-hospital mortality (8% vs 0.4%), 12-month mortality (21% vs 5%), and risk of short-term and long-term cardiovascular complications<br /> * The degree of troponin elevation corresponds inversely with outcomes<br /> <br /> == Diagnosis ==<br /> <br /> * Based on troponin thresholds<br /> ** Non-high-sensitivity troponin T (TnT) ≥0.03 ng/mL<br /> ** High-sensitivity troponin T (hsTnT) 20 to &lt;65 ng/L with absolute change of ≥5 ng/L, or ≥65 ng/L<br /> <br /> == Management ==<br /> <br /> === Screening ===<br /> <br /> * Routine screening should be done for patients with RCRI ≥1, age ≥65 years, age 45-64 years with significant cardiovascular disease, elevated preoperative NT-proBNP ≥300 ng/L, or elevated BNP ≥92 mg/L<br /> * For these high-risk patients, follow [[troponin]] and [[ECG]] daily after surgery, with for 48 to 72 hours or until peak<br /> <br /> === Management ===<br /> <br /> ==== In Hospital ====<br /> <br /> * Assess for high risk signs or symptoms, including persistent chest pain, ST elevation, new LBBB, dynamic ECG changes, or hemodynamic instability<br /> ** Consider inpatient echocardiogram, cardiac catheterization, and Cardiology consultation<br /> ** Consider risk stratification with cardiac stress testing<br /> * Manage non-ischemic causes of troponin rise, including [[anemia]], [[tachycardia]], [[hypotension]], [[pulmonary embolism]], and [[sepsis]]<br /> * Start cardioprotective medications, including moderate-to-high dose [[Statins|statin]] and low-dose [[aspirin]]<br /> ** Consider adding intermediate dose [[dabigatran]]<br /> ** Timing of antiplatelets and anticoagulant depends on bleeding risk and should be discussed with the surgeon<br /> * Counsel patient on modifiable risk factors for cardiovascular disease<br /> <br /> ==== After Discharge ====<br /> <br /> * Follow up within 2 to 4 weeks if possible<br /> * Risk stratification with non-invasive cardiac testing stress echo, nuclear stress test, or coronary CT angiography<br /> ** Consider PET, if available<br /> * Consider routine reassessment for at least 1 year, especially if there were high-risk features<br /> <br /> [[Category:Perioperative medicine]]<br /> [[Category:Cardiology]]</div>

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