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

  • Gary C Simpson University of KwaZulu-Natal
  • L C Marais University of KwaZulu-Natal
  • Reitze N Rodseth University of KwaZulu-Natal
  • Outcomes Research Consortium Outcomes Research Consortium
Keywords MINS, myocardial injury after non-cardiac surgery, troponin elevation, peri-operative myocardial injury, myocardial ischaemia

Abstract

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

Author Biographies

Gary C Simpson, University of KwaZulu-Natal

MBChB, DA(SA)

Anaesthetic registrar

Nelson R Mandela School of Medicine

University of KwaZulu-Natal

Pietermaritzburg

South Africa

L C Marais, University of KwaZulu-Natal

MBChB, FC Orth SA, MMed(Ortho), PhD

Department of Orthopaedics

School of Clinical Medicine

University of KwaZulu-Natal

Pietermaritzburg

South Africa

Reitze N Rodseth, University of KwaZulu-Natal

MBChB, FCA, Cert Crit Care, MMed, MSc, PhD

Perioperative Research Group

Department of Anaesthetics

Grey’s Hospital

Nelson R Mandela School of Medicine

University of KwaZulu-Natal

Pietermaritzburg

South Africa

Outcomes Research Consortium, Outcomes Research Consortium

Cleveland

Ohio

Published
2018-05-22
How to Cite
SIMPSON, Gary C et al. The silent killer: myocardial injury after non-cardiac surgery (MINS). South African Orthopaedic Journal, [S.l.], p. 12-15, may 2018. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/220>. Date accessed: 15 aug. 2018.
Section
General