Myocardial Injury After Noncardiac Surgery (MINS) in Patients Undergoing Knee and Hip Arthroplasty

Cardiovascular complications that develop during the perioperative period stand out as a significant cause of morbidity and mortality in patients after surgery. Especially myocardial injury (MINS) occurring after non-cardiac surgeries often progresses without clinical symptoms and signs, and therefore its diagnosis can be missed. The early detection of this silent damage is of great importance for patient safety and treatment management. It is reported that 5% to 25% of patients after non-cardiac surgery have elevated cardiac troponin (cTn) levels, and most of these patients are asymptomatic. This situation suggests that many patients are exposed to undetected myocardial damage. In patients who have experienced myocardial infarction (MI) or myocardial injury, morbidity and mortality rates are high not only before surgery but also on the 30th day and even up to the 1st year. MINS is typically detected during the perioperative period through measurements of cardiac troponin I (cTnI) or cardiac troponin T (cTnT).

These proteins are the fundamental regulatory proteins of the myocardium and are sensitive and specific biomarkers for myocardial damage. Elevations in troponin levels should be identified within the first 30 days, but these elevations typically occur within the first 2 days of the postoperative period. When high-sensitivity troponin T (hs-cTnT) measurements are used, an increase of 5 ng/L or more over the previous value has been independently associated with 30-day mortality in a major international study. The aim of this study is to determine the incidence of myocardial injury after non-cardiac surgery (MINS) in patients undergoing elective total knee or hip arthroplasty and to identify the demographic, clinical, laboratory, and surgical risk factors that may contribute to it.

Inclusion criteria

• Age over 45
• Elective total knee or hip replacement

Exclusion criteria

• Those undergoing cardiac surgery
• History of acute MI (<30 days)
• Chronic elevation of troponin