Physician Strategies for Management of Myocardial Injury Following Non-Cardiac Surgery (MINS). Results from an International Cross-Sectional Electronic Survey

Abstract

Introduction and objectives: Myocardial injury after non-cardiac surgery (MINS) is a major cardiovascular complication in surgical patients and is associated with an increased short- and long-term mortality. This study evaluated physicians' perspectives, awareness, and practices regarding MINS, focusing on risk stratification, diagnostic, and therapeutic interventions. Methods: A cross-sectional survey was conducted among physicians involved in postoperative care. A questionnaire, including a clinical case meeting MINS criteria, was distributed online between November and December 2024. Descriptive and inferential statistics were used to analyze responses, with associations examined using chi-square and t-tests. Results: A total of 143 participants completed the survey, including vascular surgeons (25.9%), anesthesiologists (23.8%), and cardiologists (14.7%). Most respondents used electrocardiograms (ECG) (88.8%) for perioperative risk assessment, while echocardiography was recommended by 52.5% when the ECG was normal. However, there was no consensus on the necessity of advanced cardiac testing, with 38.5% supporting stress testing. Pharmacological strategies also varied preoperatively and postoperatively, with acetylsalicylic acid (47.6% and 81.1%, respectively) and statins (42.7% and 76.2%, respectively) being the most recommended agents and with a limited use of anticoagulants and antiplatelet agents. Most participants (76,9%) agreed on outpatient follow-up with a medicine specialist within a year after surgery. Conclusions: This study highlights significant heterogeneity in MINS diagnosis and management across medical specialties. While ECG and echocardiography were widely accepted, advanced cardiac testing and pharmacological interventions lacked consensus. These findings emphasize the need for standardized guidelines to improve MINS identification and treatment, ensuring better outcomes for high-risk patients.