RT Book, Section
A1 Cohn, Steven L.
A2 Cohn, Steven L.
SR Print(0)
ID 1179531853
T1 Myocardial Injury after Noncardiac Surgery (MINS)
T2 Decision Making in Perioperative Medicine: Clinical Pearls
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781260468106
LK accessmedicine.mhmedical.com/content.aspx?aid=1179531853
RD 2024/04/23
AB Myocardial  injury  is  defined  as  an  elevated  troponin  above  the  99th  percentile  upper  reference  level  and  is  classified  into  three  groups:  1)  acute  myocardial  infarction  (MI)  in  which  there  is  a  rise  and  fall  of  troponin  with  at  least  one  elevated  value  plus  symptoms,  ECG  changes,  or  imaging  suggesting  an  ischemic  etiology;  2)  acute  nonischemic  myocardial  injury  (NIMI)  in  which  there  is  a  similar  rise  and  fall  in  troponin  but  no  signs  or  symptoms  of  ischemia;  and  3)  chronic  myocardial  injury  in  which  there  is  an  elevated  troponin  but  no  rise  and  fall  pattern.  Acute  MI  is  further  defined  as  Type  I  with  acute  plaque  rupture  or  Type  II  where  there  is  an  oxygen  supply-demand  mismatch.  Myocardial  injury  after  noncardiac  surgery  (MINS)  is  defined  as  an  elevated  troponin  with  a  rise  and  fall  pattern  occurring  within  30  days  of  surgery  and  presumed  to  be  of  ischemic  etiology  but  not  required  to  meet  criteria  for  MI.1  Definitions  vary  somewhat  among  investigators  based  on  troponin  used,  specific  criteria  defining  an  elevated  value,  and  need  for  absolute  change  in  levels.2  Troponin  elevations  can  be  seen  in  many  conditions,  both  ischemic  and  nonischemic  (Table  36-1).