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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X


SIMPSON, GC; MARAIS, LC  and  RODSETH, RN. The silent killer: myocardial injury after non-cardiac surgery (MINS). SA orthop. j. [online]. 2018, vol.17, n.2, pp.12-15. ISSN 2309-8309.

INTRODUCTION: Recent work into the causes of death after non-cardiac surgery has identified a new clinical concept, namely myocardial injury after non-cardiac surgery (MINS). The pathophysiology is related to a supply-and-demand mismatch in the peri-operative period and differs from the traditional model of myocardial ischaemia and infarction. METHODS: Literature review of current body of knowledge and recent large multicentre clinical trials. RESULTS: MINS is associated with increased morbidity and mortality at 30 days' post-surgery. A large international multicentre trial found that a troponin T level of greater than 0.3 ng/ml was associated with a mortality rate of 16.9%. Moreover, 84.2% of MINS would probably go undetected if systematic troponin monitoring after surgery was not performed CONCLUSION: This review examines the current body of knowledge and provides practical guidelines on how to identify and manage patients with MINS. LEVEL OF EVIDENCE: Level 5.

Keywords : MINS; myocardial injury after non-cardiac surgery; troponin elevation; peri-operative myocardial injury; myocardial ischaemia.

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