Predictors of Myocardial Injury after Non-Cardiac Surgery (MINS): a retrospective single-center cohort study

Le résumé fourni par la source

Abstract Background Myocardial injury after non-cardiac surgery (MINS) is a common and serious postoperative complication associated with increased morbidity and mortality. Various risk factors of MINS have been reported, including those in the revised cardiac risk index (RCRI), such as coronary artery disease, heart failure, cerebrovascular disease, insulin-dependent diabetes, and chronic kidney disease. However, the role of surgical factors in MINS development remains poorly established. This study aimed to investigate perioperative factors associated with MINS and determine whether any additional risk factors could be identified. Methods This retrospective single-center cohort study was conducted at our hospital between January 1, 2020, and December 31, 2022. We included patients undergoing non-cardiac surgery who were at risk for perioperative cardiovascular events, defined as having RCRI ≥1 or ≥3 coronary risk factors (hypertension, dyslipidemia, diabetes mellitus, or smoking habit). Postoperative high-sensitivity troponin I (hs-TnI) measurements were obtained for all patients. All patients underwent a 12-lead electrocardiogram (ECG) within one hour postoperatively, and hs-TnI levels were measured on the first and third postoperative days. MINS was defined as hs-TnI elevation (≥32 pg/mL) within three postoperative days. Results Among the 3,286 patients, 447 (13.6%) developed MINS. Univariate analysis showed a higher incidence of MINS in patients with prolonged surgical duration (≥185 min: 15.2% vs. 12.2%, p = 0.0108), age ≥70 years (18.6% vs. 6.7%, p < 0.0001), and emergency surgery (25.1% vs. 11.4%, p < 0.0001). Multivariable logistic regression analysis confirmed these factors as independent predictors of MINS. Surgery lasting ≥185 minutes was associated with a 1.76-fold increased risk of MINS (95% CI: 1.41–2.20, p < 0.0001). Patients aged ≥70 years had a 3.01-fold higher risk (95% CI: 2.37–3.83, p < 0.0001), while emergency surgery carried the highest risk (OR 3.20, 95% CI: 2.48–4.13, p < 0.0001). The predictive model incorporating these factors demonstrated moderate discriminative ability (AUC = 0.6876). Conclusions We identified prolonged surgical duration, advanced age, and emergency surgery as independent predictors of MINS, even after adjusting for known clinical risk factors. These findings suggest that surgical complexity, in addition to conventional cardiovascular risk indices, should be considered in perioperative risk assessment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.