KALP DIŞI CERRAHİ SONRASI MİYOKARD YARALANMASININ GÖRÜLME SIKLIĞI VE TAHMİN EDİCİLERİ: ÜÇÜNCÜ BASAMAK BİR MERKEZDEN RETROSPEKTİF BİR KOHORT ANALİZİ

Öz

Amaç: Kalp dışı cerrahi sonrası miyokard hasarı (MINS), belirgin iskemik semptomlar olmaksızın yüksek kardiyak troponin seviyeleri ile karakterize, yaygın ve sıklıkla gözden kaçan bir perioperatif komplikasyondur. Artmış morbidite ve mortalite ile güçlü bir şekilde ilişkilidir. Bu çalışmanın amacı, MINS insidansını belirlemek, perioperatif risk faktörlerini belirlemek ve erken postoperatif mortalite üzerindeki etkisini değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif kohort çalışmasına Ocak 2024 ile Mayıs 2025 arasında kalp dışı cerrahi geçiren ve üçüncü basamak bir hastanenin yoğun bakım ünitesine yatırılan 418 yetişkin hasta dahil edildi. Yüksek duyarlılıklı troponin I seviyeleri postoperatif 1,24 ve48. saatlerde ölçüldü. MINS, kadınlarda troponin I >17 ng/L ve erkeklerde >35 ng/L olarak tanımlandı. Demografik veriler, cerrahi değişkenler, eşlik eden hastalıklar ve sonuçlar analiz edildi. Lojistik regresyon, MINS ve mortalitenin bağımsız öngörücülerini belirledi. Bulgular: Hastaların %28,5′inde MINS tespit edildi. Erkek cinsiyet (OR=1, 61; %95 GA:1,032,53), ameliyat türü (p=0,034) ve elektif cerrahi ile anlamlı şekilde ilişkiliydi ve acil vakalarda paradoksal olarak daha düşük bir insidans vardı (OR=0,51; %95 GA:0,330,81). Ameliyat sonrası mortalite MINS grubunda anlamlı şekilde daha yüksekti (%18,5′e karşı %4, p<0,001). Mortalitenin bağımsız öngörücüleri arasında acil ameliyat (OR=8,39), daha uzun yoğun bakımda kalış (OR=1,12/gün) ve daha düşük vücut kitle indeksi (p=0,02) yer aldı. Sonuç: MINS, olumsuz klinik sonuçlara önemli ölçüde katkıda bulunan yaygın bir postoperatif komplikasyondur. Yüksek riskli hastalarda rutin postoperatif troponin sürveyansı, daha erken tanı ve tedaviyi destekleyebilir. MINS’in olumsuz klinik sonuçlarını azaltmak için perioperatif stratejilerin optimize edilmesi esastır.

Anahtar Kelimeler

• Miyokard hasarı
• MINS
• kalp dışı cerrahi
• troponin
• postoperatif mortalite
• risk faktörleri
• retrospektif kohort

INCIDENCE AND PREDICTORS OF MYOCARDIAL INJURY AFTER NONCARDIAC SURGERY: A RETROSPECTIVE COHORT ANALYSIS FROM A TERTIARY CENTRE

Öz

Objective: Myocardial injury after noncardiac surgery (MINS) is a prevalent and frequently underdiagnosed perioperative complication, characterised by elevated cardiac troponin levels in the absence of overt ischaemic symptoms. It is strongly associated with increased morbidity and mortality. This study aimed to deter mine the incidence of MINS, identify its perioperative risk factors, and evaluate its impact on early postoperative mortality. Material and Methods: This retrospective cohort study included 418 adult patients who underwent noncardiac surgery between January 2024 and May 2025 and were admitted to a tertiary hospital intensive care unit (ICU). Highsensitivity troponin I levels were measured at 1, 24, and 48 h postoperatively. MINS was defined as troponin I >17 ng/L in females and >35 ng/L in males. Demographic data, surgical variables, comorbidities, and outcomes were analysed. Logistic regression analysis identified independent predictors of MINS and mortality. Results: MINS was detected in 28.5% of patients. It was significantly associated with male sex (OR=1.61; 95% CI: 1.03–2.53), surgery type (p=0.034), and elective surgery, with a paradoxically lower incidence in emergency cases (OR=0.51; 95% CI: 0.33–0.81). Postoperative mortality was significantly higher in the MINS group (18.5% vs. 4%, p<0.001). Independent predictors of mortality included emergency surgery (OR=8.39), longer ICU stay (OR=1.12 per day), and lower body mass index (p=0.02). Conclusion: MINS constitutes a prevalent postoperative complication that significantly contributes to adverse clinical outcomes. Routine postoperative troponin surveillance in highrisk patients may support earlier diagnosis and management. Optimising perioperative strategies is essential to mitigate the adverse clinical consequences of MINS.

Anahtar Kelimeler

• Myocardial injury
• MINS
• noncardiac surgery
• troponin
• postoperative mortality
• risk factors
• retrospective cohort

Kaynakça

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