Myocardial Injury after Noncardiac Surgery (MINS) Risk Predictor
- Myocardial Injury after Noncardiac Surgery (MINS): Explanation and Clinical Context
MINS refers to myocardial injury occurring within 30 days after noncardiac surgery, attributed to ischemic mechanisms and detected by postoperative cardiac troponin elevation. It is common, often clinically silent, and independently associated with short-term and long-term mortality. The preoperative model implemented here estimates individual risk of developing MINS using three readily available factors at the anesthesia clinic: age, American Society of Anesthesiologists (ASA) physical status, and whether the planned surgery is vascular. This model was derived from the MANAGE cohort and reported good discrimination and calibration; its logistic equation is applied exactly as published, so the output represents the original predicted probability. Use this tool to support risk conversations, troponin surveillance planning, and optimization before surgery. It is not a substitute for clinical judgment, comprehensive perioperative assessment, or institutional protocols.
Reference:
Serrano AB, et al. Preoperative clinical model to predict myocardial injury after non-cardiac surgery. BMJ Open. 2021;11:e045052. Equation: Y = −3.647 + 0.020×(age−45) + 0.744 (ASA III) + 1.859 (ASA IV) + 0.536 (vascular surgery); Probability = exp(Y)/(1+exp(Y)).
Devereaux PJ, et al. VISION Study and subsequent analyses defining MINS and its prognostic relevance and troponin thresholds.
Ruetzler K, et al. Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery. Circulation. 2021;144:e287–e305. Guidance on definition, surveillance, and management.
Notes on Use:
The prediction reflects preoperative risk before intraoperative factors are known. Consider postoperative troponin surveillance in higher-risk patients and integrate other validated tools (e.g., RCRI, Gupta MICA) and biomarkers (e.g., NT-proBNP) when available to refine global perioperative cardiac risk.
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