Devereaux P J, Szczeklik Wojciech
Department of Health Research Methods, Evidence, and Impact, McMaster University, David Braley Research Building, c/o Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
Population Health Research Institute, David Braley Research Building, c/o Hamilton General Hospital, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada.
Eur Heart J. 2020 May 1;41(32):3083-3091. doi: 10.1093/eurheartj/ehz301.
Myocardial injury after non-cardiac surgery (MINS) is due to myocardial ischaemia (i.e. supply-demand mismatch or thrombus) and is associated with an increased risk of mortality and major vascular complications at 30 days and up to 2 years after non-cardiac surgery. The diagnostic criteria for MINS includes an elevated post-operative troponin measurement judged as resulting from myocardial ischaemia (i.e. no evidence of a non-ischaemic aetiology), during or within 30 days after non-cardiac surgery, and without the requirement of an ischaemic feature (e.g. ischaemic symptom, ischaemic electrocardiography finding). For patients with MINS who are not at high risk of bleeding, physicians should consider initiating dabigatran 110 mg twice daily and low-dose aspirin. Physicians should also consider initiating statin therapy in patients with MINS. Most MINS patients should only be referred to cardiac catheterization if they demonstrate recurrent instability (e.g. cardiac ischaemia, heart failure). Patients ≥65 years of age or with known atherosclerotic disease should have troponin measurements on days 1, 2, and 3 after surgery while the patient is in hospital to avoid missing >90% of MINS and the opportunity to initiate secondary prophylactic measures and follow-up.
非心脏手术后心肌损伤（MINS）是由心肌缺血（即供需不匹配或血栓形成）引起的，与非心脏手术后30天及长达2年的死亡风险和主要血管并发症增加相关。MINS的诊断标准包括在非心脏手术期间或术后30天内，术后肌钙蛋白测量值升高，且判断为心肌缺血所致（即无非缺血性病因证据），且无需缺血特征（如缺血症状、缺血性心电图表现）。对于出血风险不高的MINS患者，医生应考虑开始每日两次服用110毫克达比加群和低剂量阿司匹林。医生还应考虑在MINS患者中开始他汀类药物治疗。大多数MINS患者只有在出现反复不稳定情况（如心肌缺血、心力衰竭）时才应进行心脏导管检查。≥65岁或患有已知动脉粥样硬化疾病的患者应在术后住院期间的第1、2和3天进行肌钙蛋白测量，以避免漏诊超过90%的MINS病例以及错过启动二级预防措施和随访的机会。
