Silent but Deadly: Myocardial Injury After Noncardiac Surgery (MINS)

While often silent,?Myocardial Injury After Noncardiac Surgery (MINS)?significantly increases morbidity and mortality in surgical patients. In this newsletter, we review its causes, prevention, and management.

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Why This Topic Is Important

Up to 20% of adult surgical patients experience postoperative troponin elevation, yet most have no symptoms. Despite the lack of overt clinical signs, studies show that even small postoperative increases in troponin levels are associated with higher mortality and cardiovascular complications for up to a year after surgery. Given that MINS remains largely undetected without troponin screening, early identification and intervention are critical.

How the Authors Did the Study

Wittmann et al. conducted a narrative review of the latest literature on:

• The definition and epidemiology of MINS
• Potential perioperative triggers that contribute to myocardial injury
• Preventive measures to mitigate risk
• Management strategies that improve patient outcomes

The review analyzed large-scale cohort studies and clinical trials that have shaped our current understanding of MINS, emphasizing its high prevalence, silent nature, and deadly consequences.

What the Authors Found

1. MINS is widespread yet underdiagnosed
2. Common perioperative triggers for MINS
3. Postoperative Troponin surveillance is essential
4. No single medication prevents MINS, but some reduce risk

Breaking It Down: Why This Matters

MINS is not simply a postoperative anomaly—it is a predictor of death and major adverse cardiovascular events. Despite its prevalence, MINS lacks clear, standardized management, and many institutions do not routinely screen for it. This is a major gap in perioperative care.

Wittmann et al. emphasize that MINS is more likely caused by supply-demand mismatch rather than atherothrombosis, highlighting the importance of maintaining hemodynamic stability rather than focusing solely on clot prevention.

The takeaway? Anesthesiologists, surgeons, and intensivists must collaborate to actively prevent, identify, and manage MINS in high-risk patients.

Key Takeaways for Clinicians

To prevent and manage MINS, consider these evidence-based strategies:

Preoperative risk stratification

• Identify high-risk patients (e.g., age > 65, preexisting CAD, diabetes, chronic kidney disease).
• Consider baseline troponin and BNP testing for risk assessment.

Intraoperative management

• Avoid hypotension: Keep MAP >65 mmHg using vasopressors when necessary.
• Control tachycardia: Prevent excessive sympathetic activation.
• Maintain normothermia: Hypothermia increases cardiac stress.
• Optimize oxygenation and hemoglobin levels: Liberal transfusion strategies may benefit select high-risk patients.

Postoperative monitoring and management

• Screen troponin levels at 6-12 hours post-op and daily for 2-3 days in high-risk patients.
• Manage pain effectively to reduce catecholamine surges.
• Consider secondary prevention medications (statins, aspirin, anticoagulants) in patients diagnosed with MINS.
• Ensure cardiology follow-up for long-term risk reduction.

Final Thoughts

MINS is a silent but deadly complication that demands proactive surveillance and intervention. Troponin monitoring, hemodynamic stability, and secondary prevention strategies can help improve patient outcomes and reduce perioperative mortality.

For in-depth insights on MINS, explore Anesthesia Updates on the?NYSORA Anesthesia Assistant App. Access step-by-step management algorithms, the latest research, and peer-reviewed expertise—all in one place. Download the app today and experience the future of anesthesia education and decision-making.? Thank you for being part of the NYSORA community. Stay tuned for more clinically relevant updates!

Warm regards,

Dr. Admir Hadzic