Incidence of myocardial injury after non-cardiac surgery: Experience at Groote Schuur Hospital, Cape Town, South Africa

Abstract

Background. Myocardial injury after non-cardiac surgery (MINS) is a newly recognised entity identified as an independent risk factor associated with increased 30-day all-cause mortality. MINS increases the risk of death in the perioperative period by ~10-fold. More than 80% of patients with MINS are asymptomatic, so the majority of diagnoses are missed. Awareness of MINS is therefore important for perioperative physicians. Objectives. To investigate the incidence of MINS after elective elevated-risk non-cardiac surgery at Groote Schuur Hospital, Cape Town, South Africa (SA). Methods. Patients aged ≥45 years undergoing elective elevated-risk non-cardiac surgery were enrolled via convenience sampling. The new fifth-generation high-sensitivity cardiac troponin T blood test was used postoperatively to identify MINS. Preoperative troponin levels were not measured. Results. Among 244 patients included in the study, the incidence of MINS was 4.9% (95% confidence interval (CI) 2.8 -8.5), which was not significantly different from that in a major international prospective observational study (VISION) (8.0% (95% CI 7.5 -8.4)); p=0.080. Conclusions. Our SA cohort had a lower cardiovascular risk profile but a similar incidence of MINS to that described in international literature. The impact of MINS on morbidity and mortality is therefore likely to be proportionally higher in SA than in published international studies. The limited sample size and lower event rate weaken our conclusions. Larger studies are required to establish patient and surgical risk factors for MINS, allowing for revision of cardiovascular risk prediction models in SA.

Magnitude and associated factors of intraoperative cardiac complications among geriatric patients who undergo non-cardiac surgery at public hospitals in the southern region of Ethiopia: a multi-center cross-sectional study in 2022/2023

“…Therefore, knowing physiological changes and avoiding intraoperative hemodynamic instability can help decrease ICC. However, the findings of current study disagree with the findings of the studies reported in most central and eastern European countries, including the USA ( 28 , 29 ). In many central and eastern European countries, the mortality rates of geriatric patients have declined in those aged over 65 years.…”

Myocardial injury after non-cardiac surgery: Time to shed the ignorance

“…[3] A recent study found that the incidence of MINS in a South African (SA) patient population was comparable with those of large international cohorts. [11] The 1 500 SA patients included in the VISION cohort also suggested findings that could be compared with those of other international cohorts, and showed no evidence of differences between clusters. [6,7] It is therefore reasonable to assume that the SA patient population has a similar risk for MINS and outcomes after MINS to that in the literature.…”

Dabigatran for the Prevention of Myocardial Injury after Orthopedic Surgery (DMINS-PRE). A Study Protocol For A Randomized, Active-Controlled, Phase II Trial

“…The incidence of MINS was reported to be 5-8%, making it a frequent complication (Botto et al, 2014, Coetzee et al, 2018 in the post-operative scenario, associated with a 4-time increase in mortality population (Devereaux et al, 2017). Due to this clinical significance, proper treatment and prophylaxis for MINS are necessary.…”