Circulation. 2021 Nov 9;144(19):e287-e305. doi: 10.1161/CIR.0000000000001024. Epub 2021 Oct 4.
Myocardial injury after noncardiac surgery is defined by elevated postoperative cardiac troponin concentrations that exceed the 99th percentile of the upper reference limit of the assay and are attributable to a presumed ischemic mechanism, with or without concomitant symptoms or signs. Myocardial injury after noncardiac surgery occurs in ≈20% of patients who have major inpatient surgery, and most are asymptomatic. Myocardial injury after noncardiac surgery is independently and strongly associated with both short-term and long-term mortality, even in the absence of clinical symptoms, electrocardiographic changes, or imaging evidence of myocardial ischemia consistent with myocardial infarction. Consequently, surveillance of myocardial injury after noncardiac surgery is warranted in patients at high risk for perioperative cardiovascular complications. This scientific statement provides diagnostic criteria and reviews the epidemiology, pathophysiology, and prognosis of myocardial injury after noncardiac surgery. This scientific statement also presents surveillance strategies and treatment approaches.
非心脏手术后心肌损伤的定义为术后心脏肌钙蛋白浓度升高，超过检测方法上限参考值第 99 百分位，并归因于假定的缺血机制，无论是否伴有伴随症状或体征。约 20%接受大型住院手术的患者发生非心脏手术后心肌损伤，大多数患者无症状。非心脏手术后心肌损伤与短期和长期死亡率独立且密切相关，即使没有符合心肌梗死的心肌缺血的临床症状、心电图改变或影像学证据。因此，对于围手术期心血管并发症高危患者，有必要监测非心脏手术后心肌损伤。本科学声明提供了诊断标准，并回顾了非心脏手术后心肌损伤的流行病学、病理生理学和预后。本科学声明还介绍了监测策略和治疗方法。
