Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.
The authors report the results of the VISION study (Vascular Events in Noncardiac Surgery Patients Cohort Evaluation), a large international, prospective, observational study of non-cardiac surgery patients that aimed to determine the pathophysiology of cardiovascular events and develop optimal models for predicting perioperative mortality and morbidity. The goals of this study were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of myocardial injury after non-cardiac surgery (MINS). Age, preoperative co-morbidities, preoperative decreases in glomerular filtration rate (GFR), and urgent surgeries were found to be independent predictors of MINS. An elevated troponin level after non-cardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/mL or greater judged to be due to myocardial ischemia. MINS was an independent predictor of 30-day mortality. The authors conclude that evaluating patients for the diagnosis of MINS compared with myocardial infarction will allow physicians to avoid missing the majority of the patients who develop a relevant perioperative myocardial injury.
– David Faraoni