Myocardial Injury after Noncardiac Surgery: A Large, International, Prospective Cohort Study Establishing DiagnosticCriteria, Characteristics, Predictors, and 30-day Outcomes

TheVascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION)Writing Group, on behalf of The Vascular events In noncardiac Surgery patIentscOhort evaluatioN (VISION) Investigators. Anesthesiology 03 2014,Vol.120, 564-578.

International,prospective cohort study of 15,065 patients > 45 yr, having noncardiac surgery.

TroponinT was measured first 3 postoperative days. Diagnosticcriterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judgeddue to myocardial ischemia.

MINSwas an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87;95% CI, 2.96?5.08) and had the highest population-attributable risk (34.0%, 95%CI, 26.6?41.5) of the perioperative complications.

1,200 patients (8.0%) suffered MINS, and over half (58.2%) of these patients would nothave fulfilled the universal definition of myocardial infarction. Fewer than one in five (15.8%) patients with MINS experienced an ischemic symptom.

Among adults undergoing noncardiacsurgery, MINS is common and associated with substantial mortality.

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