Introduction: Myocardial injury is defined as an elevation of troponin due to ischemic causes, with or without clinical signs. In the myocardial injury after noncardiac surgery (MINS), troponin elevation usually occurs without signs of ischemia. The etiology of this perioperative pathology, is in most cases based on a mismatch between oxigen supply and demand. Recently, expert consensus and european guidelines suggest the implementation of diagnostic tools for perioperatory screening of patients at risk of MINS.
Aims: to evaluate the clinical course of patients who have experienced MINS in the last two years in our hospital, in order to identity the lacks of our diagnostic and terapeutic tools.
Methods: we retrospectively evaluated 122 consecutive patients who experienced MINS in the perioperative period from january 2021 to december 2022. For each patient, we have collected data regarding clinical , strumental and laboratoristics characteristics, such as biomarkers, risk factors and type/urgency of surgery.
Results: more than half of patients with MINS (54%) had a low patient-related risk, whereas only 17% of them had a high risk. Regarding the surgery-related risk, only a third of patients (33.6%) had high risk related to the type or urgency of surgery, whereas two thirds of them (66.3%) had low or intermediate risk related to surgery. Combining these risks, resulted that only a minority of patients (5%) had both patient related and surgery-related risk, whereas less than a half (42%) of patients had a high patient related or high surgery related risk. Instead, most of the patients (68%) had low patient-related risk or low surgery related risk. All patients had a pre-operative electrocardiogram. More than a half (54,9%) of patients had a pre-operative transthoracic echocardiography. Large majority (95,6%) of patients had a pre-operative troponin.
Conclusion: careful assessment with patient-related and surgery-related cross risk, such as adoption of common diagnostic tools did not allow us to adopt an effective peri-operative screening for patients at risk of MINS.