Myocardial injury after non cardiac surgery: a perioperative affair?

Myocardial injury after non cardiac surgery (MINS) is a rather new nosological entity and an unfortunately common perioperative complication. The diagnostic criteria for MINS, also indicated as isolated myocardi- al injury (IMI), are an elevated postoperative high sensitivity Troponin T (hsTnT level ranging between 20 and 65 ng/L with an absolute change of at least 5 ng/L or hsTnT level > 65 ng/L), in absence of symptoms and/or EKG findings suggestive of ischemia and without a non ischemic aetiology causing Troponin eleva- tion. MINS does not fulfill the universal definition of myocardial infarction even if it is related to ischemic causes and it is independently associated with 30-day postoperative mortality and complications. Neverthe- less, mortality at 30 days in MINS patients has been calculated up to 10% and it increases exponentially as a function of peak postoperative Troponin concentration. Physician and researchers should discriminate MINS from perioperative myocardial infarction and from not ischemic Troponin increases. In the postop- erative period, the possibility of missing the diagnosis of an acute coronary syndrome for the paucity of clinical symptoms or because physician failed to evaluate a postoperative EKG recording should always be considered. Physiopathology of MINS is not yet well defined: current hypotheses are surrogated from peri- operative myocardial infarction studies. Up to now there aren't specific treatments for MINS, even if an- tithrombotic therapy is under evaluation. Treatment decisions should be tailored to the individual case; po- tential benefits of Troponin screening include a cardiology consultation and consequently, improved pa- tients' information to promote lifestyle changes and enhanced therapy.