Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2022 Feb;75(1):4-11. doi: 10.4097/kja.21372. Epub 2021 Oct 18.
Myocardial injury is defined as an elevation of cardiac troponin (cTn) levels with or without associated ischemic symptoms. Robust evidence suggests that myocardial injury increases postoperative mortality after noncardiac surgery. The diagnostic criteria for myocardial injury after noncardiac surgery (MINS) include an elevation of cTn levels within 30 d of surgery without evidence of non-ischemic etiology. The majority of cases of MINS do not present with ischemic symptoms and are caused by a mismatch in oxygen supply and demand. Predictive models for general cardiac risk stratification can be considered for MINS. Risk factors include comorbidities, anemia, glucose levels, and intraoperative blood pressure. Modifiable factors may help prevent MINS; however, further studies are needed. Recent guidelines recommend routine monitoring of cTn levels during the first 48 h post-operation in high-risk patients since MINS most often occurs in the first 3 days after surgery without symptoms. The use of cardiovascular drugs, such as aspirin, antihypertensives, and statins, has had beneficial effects in patients with MINS, and direct oral anticoagulants have been shown to reduce the mortality associated with MINS in a randomized controlled trial. Myocardial injury detected before noncardiac surgery was also found to be associated with postoperative mortality, though further studies are needed.
心肌损伤定义为心肌肌钙蛋白（cTn）水平升高，伴有或不伴有相关的缺血症状。强有力的证据表明，心肌损伤会增加非心脏手术后的死亡率。非心脏手术后心肌损伤（MINS）的诊断标准包括手术 30 天内 cTn 水平升高，且无非缺血性病因的证据。大多数 MINS 病例没有缺血症状，是由氧供需不匹配引起的。可考虑使用一般心脏风险分层的预测模型来预测 MINS。危险因素包括合并症、贫血、血糖水平和术中血压。可改变的因素可能有助于预防 MINS；然而，还需要进一步的研究。最近的指南建议在高危患者手术后的头 48 小时内常规监测 cTn 水平，因为 MINS 通常在手术后 3 天内发生，且没有症状。在 MINS 患者中，使用心血管药物，如阿司匹林、降压药和他汀类药物，已显示出有益的效果，并且在一项随机对照试验中，直接口服抗凝剂已被证明可以降低与 MINS 相关的死亡率。在非心脏手术前检测到的心肌损伤也与术后死亡率有关，但还需要进一步的研究。
