Controversies in perioperative troponin elevation in non-cardiac surgery

Abstract

The Fourth Universal Definition of Myocardial Infarction recognizes “myocardial injury” as a distinct entity with a milder form of myocardial necrosis leading to the release of detectable troponin. Myocardial injury after non-cardiac surgery (MINS) is the release of detectable troponin in the absence of symptoms within 30-day. MINS has been increasingly recognized as it has a prognostic bearing on outcomes. However, the diagnosis, interpretation, implication, and treatment strategies are yet to be resolved. Definitions of diagnosis have changed from the fourth generation to fifth-generation (high-sensitivity troponin), which still is proprietary and lack universal standardization; interpretation in studies have varied depending on definitions based on fourth or fifth generation troponin assays. Other than prognostic implications, either equivocal results or limited studies exist for the utility for prevention and screening of MINS. Additionally, the studied strategies and drugs to prevent MINS have either failed to translate in clinical trials in humans, or showed inconclusive results. We, as a result of this, in our review, highlight such facts regarding elevation in perioperative troponin faced by the practicing perioperative clinician regularly.

Keywords

Perioperative myocardial infarction / myocardial injury / myocardial injury after non-cardiac surgery / high-sensitivity troponin / cardiac troponin

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