Journal article
Myocardial Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis.
- Smilowitz NR From the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
- Redel-Traub G From the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
- Hausvater A From the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
- Armanious A From the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
- Nicholson J Department of Library Sciences, New York University School of Medicine, New York, NY.
- Puelacher C Department of Cardiology and Cardiovascular Research Institute Basel, University of Basel, Basel, Switzerland.
- Berger JS From the Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
- 2019-04-16
Published in:
- Cardiology in review. - 2019
English
Myocardial injury after noncardiac surgery (MINS) is a common postoperative complication associated with adverse cardiovascular outcomes. The purpose of this systematic review was to determine the incidence, clinical features, pathogenesis, management, and outcomes of MINS. We searched PubMed, Embase, Central and Web of Science databases for studies reporting the incidence, clinical features, and prognosis of MINS. Data analysis was performed with a mixed-methods approach, with quantitative analysis of meta-analytic methods for incidence, management, and outcomes, and a qualitative synthesis of the literature to determine associated preoperative factors and MINS pathogenesis. A total of 195 studies met study inclusion criteria. Among 169 studies reporting outcomes of 530,867 surgeries, the pooled incidence of MINS was 17.9% [95% confidence interval (CI), 16.2-19.6%]. Patients with MINS were older, more frequently men, and more likely to have cardiovascular risk factors and known coronary artery disease. Postoperative mortality was higher among patients with MINS than those without MINS, both in-hospital (8.1%, 95% CI, 4.4-12.7% vs 0.4%, 95% CI, 0.2-0.7%; relative risk 8.3, 95% CI, 4.2-16.6, P < 0.001) and at 1-year after surgery (20.6%, 95% CI, 15.9-25.7% vs 5.1%, 95% CI, 3.2-7.4%; relative risk 4.1, 95% CI, 3.0-5.6, P < 0.001). Few studies reported mechanisms of MINS or the medical treatment provided. In conclusion, MINS occurs frequently in clinical practice, is most common in patients with cardiovascular disease and its risk factors, and is associated with increased short- and long-term mortality. Additional investigation is needed to define strategies to prevent MINS and treat patients with this diagnosis.
- Language
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- English
- Open access status
- green
- Identifiers
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- DOI 10.1097/CRD.0000000000000254
- PMID 30985328
- Persistent URL
- https://sonar.ch/global/documents/165607
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