Department of Angiology and Vascular Surgery, CHU de S. João, Porto, Portugal -
Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal -
J Cardiovasc Surg (Torino). 2021 Apr;62(2):130-135. doi: 10.23736/S0021-9509.20.11205-9. Epub 2020 Sep 4.
Myocardial injury after non-cardiac surgery (MINS) stands for myocardial injury due to ischemia that occurs during or within 30-days after non-cardiac surgery. Although MINS is known to be independently associated with 30-day mortality after intervention, little is described about the impact of MINS after vascular procedures, particularly after endovascular aneurysm repair (EVAR).
This is an observational, retrospective, single-centered study. All patients underwent elective standard EVAR between January 2008 and June 2017, and them with at least one postoperative measurement of troponin I in the first 48 h after surgery, were retrospectively included. MINS was defined as the value exceeding the 99 percentile of a normal reference population with a coefficient of variation <10%. Primary outcomes include the prevalence of MINS in this subset of EVAR patients, as well as its impact in mid-term all-cause mortality. As secondary aim, the preoperative predictors of MINS were also assessed.
One-hundred and thirty-six patients with postoperative troponin measurements were included (95.6% male; mean age 75.51years). MINS was diagnosed in 16.2% (N.=22) of the patients, and in 86.4% of the cases (N.=19) it was completely asymptomatic. Heart failure (31.8% vs. 10.5%, P=0.016), ASA Score ≥3 (95.5% vs. 67.5%, P=0.004), pre-operative (P=0.036) and postoperative (P=0.04) hemoglobin concentrations ≤12 g/dL were found to be significantly associated with MINS. Regarding remaining baseline characteristics, anesthesia and femoral access, no further differences were observed. Survival at 1, 3 and 5 years was 92% (95% CI: 4.6-6.9, standard error [SE] 0.023), 81% (95% CI: 5.6-7.6, SE=0.034) and 71% (95% CI: 6.9-8.7, SE=0.04), with two deaths reported at 30 days follow-up. MINS was found to be significantly associated with increased mid-term all-cause mortality after EVAR at 24 months follow-up (84.2±3.4% vs. 63.6±10.3%, P=0.001), with a 2.12-fold risk increase of death.
MINS is a common complication after EVAR and negatively impacts the mid-term prognosis of such interventions. In the majority of cases, it is asymptomatic and, therefore, not detectable unless routine postoperative troponin measurements are performed.
非心脏手术后心肌损伤（MINS）是指非心脏手术后发生的缺血性心肌损伤，发生在手术期间或手术后 30 天内。尽管 MINS 已知与介入治疗后 30 天死亡率独立相关，但关于血管手术后（尤其是血管内动脉瘤修复术 [EVAR] 后）MINS 的影响，描述甚少。
这是一项观察性、回顾性、单中心研究。所有患者于 2008 年 1 月至 2017 年 6 月期间接受择期标准 EVAR，并在术后 48 小时内至少有一次术后肌钙蛋白 I 测量值，将其纳入回顾性分析。MINS 的定义为变异系数<10%时，超过正常参考人群第 99 百分位的数值。主要结局包括该 EVAR 患者亚组中 MINS 的发生率，以及其对中期全因死亡率的影响。作为次要目标，还评估了 MINS 的术前预测因素。
共纳入 136 例术后有肌钙蛋白测量值的患者（95.6%为男性；平均年龄 75.51 岁）。16.2%（N=22）的患者诊断为 MINS，86.4%（N=19）的患者无症状。心力衰竭（31.8% vs. 10.5%，P=0.016）、ASA 评分≥3（95.5% vs. 67.5%，P=0.004）、术前（P=0.036）和术后（P=0.04）血红蛋白浓度≤12g/dL 与 MINS 显著相关。关于其他基线特征，麻醉和股动脉入路，未观察到进一步差异。1、3 和 5 年的生存率分别为 92%（95%CI：4.6-6.9，标准误差 [SE]0.023）、81%（95%CI：5.6-7.6，SE=0.034）和 71%（95%CI：6.9-8.7，SE=0.04），在 30 天随访时有 2 例死亡。MINS 与 EVAR 后中期全因死亡率显著相关（24 个月随访时为 84.2±3.4% vs. 63.6±10.3%，P=0.001），死亡风险增加 2.12 倍。
MINS 是 EVAR 后的常见并发症，对这类干预的中期预后有负面影响。在大多数情况下，MINS 是无症状的，因此除非常规进行术后肌钙蛋白测量，否则无法检测到。
