Department of Medical Sciences (DAME), University of Udine, Udine, Italy -
Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy.
Minerva Anestesiol. 2024 Sep;90(9):797-804. doi: 10.23736/S0375-9393.24.18180-1.
Myocardial injury after non-cardiac surgery is a major issue with a rate of almost 20%, as suggested by the literature. Guidelines recommend screening patients undergoing non-cardiac surgery who have at least one cardiovascular risk factor. Clinical trials are characterized by a high degree of heterogeneity. Myocardial injury definitions vary among studies, and multiple troponin assays with different cut-offs are utilized. Myocardial injury has a poorly understood pathophysiology. While some studies only include troponin elevations that are thought to be caused by ischemia, others do not. Troponin elevation can be a result of patient-related factors and comorbidities, including age, chronic renal failure, and inflammatory status. Currently, there is no effective strategy to prevent perioperative myocardial injury, and there are no therapeutic options that significantly improve the outcome of patients with myocardial injury. We have focused on this topic and on perioperative myocardial injury to highlight the areas of research that remain unexplored.
非心脏手术后心肌损伤是一个主要问题，文献报道其发生率接近 20%。指南建议对至少存在 1 个心血管危险因素的行非心脏手术患者进行筛查。临床试验的特点是高度异质性。心肌损伤的定义在不同的研究中有所不同，并且使用了多种具有不同截断值的肌钙蛋白检测方法。心肌损伤的病理生理学尚不清楚。虽然一些研究仅包括被认为是由缺血引起的肌钙蛋白升高，但其他研究并非如此。肌钙蛋白升高可能是与患者相关的因素和合并症引起的，包括年龄、慢性肾衰竭和炎症状态。目前，还没有有效的策略来预防围手术期心肌损伤，也没有治疗方法可以显著改善心肌损伤患者的预后。我们关注这个话题和围手术期心肌损伤，以突出仍然存在的未探索的研究领域。
