Worldwide, more than 200 million adults have major noncardiac surgery annually.^1,2 Despite benefits associated with surgery, major perioperative complications, including death, occur.³ More than 1 million adults worldwide will die within 30 days of noncardiac surgery each year.^1,2

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study’s four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS. Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated “abnormal” laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria. Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors’ diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was 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. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom. Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Large observational studies suggest that among patients aged 45 years or older undergoing major noncardiac surgery, more than 1% die in hospital or within 30 days of surgery.^1,2 Myocardial injury after noncardiac surgery (MINS) is defined as myocardial injury caused by ischemia that occurs during or within 30 days after surgery and is independently associated with mortality.³ Diagnostic criteria for MINS, based on the non–high-sensitivity troponin T assay, have been identified³; however, the US Food and Drug Administration recently approved use of the high-sensitivity troponin T (hsTnT) assay, and globally, many hospitals are using high-sensitivity troponin assays.

Ndergoing pneumonectomy plus lung autotransplant were divided into 2 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Proinflammatory mediators, oxidative stress, nitric oxide metabolism, and hemodynamic and blood variables were measured at 5 different time points. RESULTS: There was an increase of oxidative stress markers and proinflammatory mediators in the propofol group, whereas the hemodynamic variables were similar in both groups. CONCLUSIONS: We demonstrated that sevoflurane decreased the inflammatory response and oxidative stress in a live ischemia–reperfusion lung model....