Table 1 MINS prevention strategies
MINS Prevention Strategies | Description | Level of Evidence | |
|---|---|---|---|
Risk assessment tools | RCRI | Calculates risk based on high-risk noncardiac surgery, history of ischemic heart disease, CHF, TIA/stroke, preoperative treatment with insulin, and preoperative creatinine over 2 mg/dL | ● Used to guide postoperative cardiac monitoring, ● Has limited predictive accuracy of cardiac events/death, especially following vascular non-cardiac surgeries |
ACS-NSQIP | ● Offers more individualized risk assessment ● based on over 135 variables ● compares performance to national standards | ● Reduction of postoperative complications and mortality by 45% and 27%, respectively ● may have limited predictive accuracy and surgical bias13 | |
Gupta Perioperative Risk for MICA | ● Similar to RCRI but more accurate at identifying high-risk patients ● Does not overestimate low-risk population ● Uses parameters specific to cardiac injury to determine risk of developing MINS | ● Factors in various surgery types, including minimally invasive, and differentiates them in the context of intra-operative and post-operative MI or cardiac arrest13 ● Retrospective data likely underestimates amounts of MI reported | |
VISION risk calculator | ● Uses the same risk factors assessed in RCRI as well as NT-proBNP levels to predict cardiovascular injury within 30 days post-operation | ● Provides updated estimates to the RCRI assessment by evaluating perioperative cardiovascular risk up to 30 days after surgery ● Limitation of external validation regarding NT-proBNP thresholds within other patient cohorts14 | |
Minimize cardiovascular risk factors | Utilize preoperative cardiac assessment by evaluating functional status, evaluation of daily activities of living, and lab work specifically biomarkers like BNP or NT-proBNP and electrocardiogram, echocardiography, and stress tests if indicated | ||
Risk factor modification | Lifestyle modifications include smoking cessation, a healthy diet, and regular physical activity Medication management for other comorbid conditions such as hypertension and diabetes mellitus | ||
Patient and provider education | Healthcare providers can impart guidance on lifestyle modifications, the importance of medication adherence, and follow-up appointments with primary caregivers and specialists | ||