Injuria miocárdica postcirugía no cardiaca (MINS) en pacientes sometidos a cirugía vascular: artículo de revisión

Abstract

Vascular surgery is considered high risk, due to the characteristics of patients and surgical procedures. Recently, the diagnosis of myocardial injury after noncardiac surgery (MINS) was introduced to focus attention on the prognostic relevance of elevated ischemic troponin after non-cardiac surgery. In the study Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION), that included more than 15,000 patients who underwent non-cardiac surgery, MINS was independently associated with mortality 3 to 4 times greater than 30 days after surgery. Biccard et al published a study derived from the study VISION in which 502 patients underwent vascular surgery, resulting in significantly higher mortality (12.5% vs 1.5%, p < 0.001) in patients who developed MINS compared to those who did not develop MINS (OR 9.48, 95% CI, 3.46-25.96). The 2014 guidelines for preoperative cardiovascular evaluation of the American College of Cardiology/American Heart Association (ACC/AHA) do not recommend the postoperative surveillance of troponin in patients without symptoms or signs of myocardial ischemia, nor in patients at high risk of coronary disease (as patients undergoing vascular surgery). On the other hand, the 2017 guidelines of the Canadian Cardiovascular Society on Perioperative Cardiac Risk, evaluation and treatment for non-cardiac surgery patients, recommend obtaining daily measurements of troponin for 48 to 72 hours after of non-cardiac surgery, in patients with a baseline risk of more than 5% of cardiovascular death or acute non-fatal myocardial infarction at 30 days after surgery. MINS is a potentially useful marker of adverse postoperative outcomes and its detection could provide opportunities to improve clinical outcomes in affected patients.