VASCULAR SURGERY AND MYOCARDIAL INJURY AFTER NONCARDIAC SURGERY (MINS): LITERATURE REVIEW
Keywords:Vascular Surgery, Myocardial injury after noncardiac surgery, peripheral artery disease, carotid endarterectomy
INTRODUCTION: After noncardiac surgery, cardiac complications are common. Recently there is one that has gained notoriety as risk factor for cardiovascular morbidity and mortality, myocardial injury after noncardiac surgery (MINS). It has an estimated incidence of 8% and is associated with an increased risk of major adverse cardiovascular events (MACE). Thus, the aim of this paper is to review the available literature regarding MINS in Vascular Surgery.
METHODS: A Medline search was performed in order to identify articles focused on MINS and its pathophysiology and effect on outcomes in Vascular Surgery. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing.
RESULTS: The incidence of MINS in Vascular Surgery is of at least 15%, higher than in other surgical specialties. As in other areas, MINS has been identified as a risk factor for cardiovascular morbidity and mortality in patients submitted to a vascular surgery. Meanwhile, troponin measurement in the post-operative period is only recommended in high risk patients. Despite the lack of consensus regarding protective factors, dabigatran and statins have showed potential as treatment after the diagnosis of MINS.
CONCLUSION: The available evidence identifies MINS as a factor that carries significant worse outcomes in patients that underwent a vascular surgery, although it remains a largely unexplored area.
2. Mauermann E, Puelacher C, Lurati Buse G. Myocardial injury after noncardiac surgery: an underappreciated problem and current challenges. Current Opinion in Anesthesiology. 2016;29(3):403-12.
3. Investigators WCftVS. Association of Postoperative High-Sen- sitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017;317(16):1642-51.
4. Croce A, Brunati P, Colzani C, Terramocci R, Favero S, Bordoni G, et al. A Rational Adoption of the High Sensitive Assay for Cardiac Troponin I in Diagnostic Routine. Dis Markers. 2017;2017:4523096-.
5. Kim M, Son M, Lee DH, Park K, Park T-H. Troponin-I Level After Major Noncardiac Surgery and Its Association With Long-Term Mortality A Retrospective Cohort With a 7-Year Follow-Up Period. International Heart Journal. 2016;57(3):278-84.
6. Smilowitz NR, Redel-Traub G, Hausvater A, Armanious A, Nicholson J, Puelacher C, et al. Myocardial Injury After Noncar- diac Surgery: A Systematic Review and Meta-Analysis. Cardio- logy in Review. 2019;27(6):267-73.
7. Zhang L-J, Li N, Li Y, Zeng X-T, Liu M-Y. Cardiac Biomarkers Predic- ting MACE in Patients Undergoing Noncardiac Surgery: A Meta-
-Analysis. Front Physiol. 2019;9:1923-.
8. Górka J, Polok K, Fronczek J, Górka K, Kózka M, Iwaszczuk P,
et al. Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk. European Journal of Vascular and Endovascular Surgery. 2018;56(2):264-70.
9. Biccard BM, Scott DJA, Chan MTV, Archbold A, Wang C-Y, Sigamani A, et al. Myocardial Injury After Noncardiac Surgery (MINS) in Vascular Surgical Patients: A Prospective Observational Cohort Study. Annals of Surgery. 2018;268(2):357-63.
10. Pereira-Macedo J, Machado N, Pereira-Neves A, Ferreira V, Oliveira-Pinto J, Dias-Neto MF, et al. Myocardial injury after aortoiliac revascularization for extensive disease: A survival analysis. Turk Gogus Kalp Dama. 2020;28:426-34.
11. Galyfos G, Tsioufis C, Theodorou D, Katsaragakis S, Zografos G, Filis K. Cardiac Troponin I after Carotid Endarterectomy in Different Cardiac Risk Patients. Journal of Stroke and Cere- brovascular Diseases. 2015;24(3):711-7.
12. Grobben RB, Vrijenhoek JEP, Nathoe HM, Den Ruijter HM, van Waes JAR, Peelen LM, et al. Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endar- terectomy. European Journal of Vascular and Endovascular Surgery. 2016;51(4):473-80.
13. Pereira-Macedo J, Rocha-Neves JP, Dias-Neto MF, Andrade JPV. Prognostic effect of troponin elevation in patients undergoing carotid endarterectomy with regional anesthesia – A pros- pective study. International Journal of Surgery. 2019;71:66-71.
14. Górka J, Polok K, Iwaniec T, Górka K, Włudarczyk A, Fronczek J, et al. Altered preoperative coagulation and fibrinolysis are associated with myocardial injury after non-cardiac surgery. British Journal of Anaesthesia. 2017;118(5):713-9.
15. Duceppe E, Patel A, Chan MTV, Berwanger O, Ackland G, Kavsak PA, et al. Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study. Ann Intern Med. 2020;172(2):96-104.
16. Dobson G, Chow L, Flexman A, Hurdle H, Kurrek M, Laflamme C, et al. Guidelines to the Practice of Anesthesia – Revised Edition 2019. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2019;66(1):75-108.
17. Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srina- than S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Canadian Journal of Cardiology. 2017;33(1):17-32.
18. Buse GL, Manns B, Lamy A, Guyatt G, Polanczyk CA, Chan MTV, et al. Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost-consequence analysis. Can J Surg. 2018;61(3):185-94.
19. Devereaux PJ, Duceppe E, Guyatt G, Tandon V, Rodseth R, Biccard BM, et al. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial. The Lancet. 2018;391(10137):2325-34.
20. Park J, Kim J, Lee S-H, Lee JH, Min JJ, Kwon J-h, et al. Posto- perative statin treatment may be associated with improved mortality in patients with myocardial injury after noncardiac surgery. Scientific Reports. 2020;10(1):11616.