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Incidence and Risk Factors of Postoperative Acute Myocardial Injury in Noncardiac Patients: A Systematic Review and Meta-analysis

Yuan Chang, Mengjiao Zhou, Jing Huang, Yanqiong Wang, Jianlin Shao.


Postoperative myocardial injury after noncardiac surgery is common and is associated with short- and long-term morbidity and mortality. However, the incidence and risk factors for postoperative acute myocardial injury (POAMI) are currently unknown due to inconsistent definitions.


More than 300 million patients worldwide yearly undergo major surgical procedures. After noncardiac surgery, myocardial injury occurs in approximately 20% of patients and is associated with short-term and long-term morbidity and mortality. According to the Fourth Universal Definition of Myocardial Infarction (2018), myocardial injury is defined as at least one value of cardiac troponins (cTn) above the 99th percentile upper reference limit of the healthy population, while the acute myocardial injury with a rise and/or fall pattern over a period.


The primary aim was to evaluate the pooled incidence of POAMI in patients following noncardiac surgery. The secondary aims were to evaluate the association of preoperative risk factors with POAMI and the effect of POAMI on postoperative 30-day and long-term mortality. Long-term follow-up is defined as a follow-up to at least six months after surgery.


This systematic review and meta-analysis revealed that the pooled incidence of POAMI was 20%. Preoperative factors, such as hypertension, diabetes, heart failure, renal impairment, and preoperative beta-blocker intake, were significant risk factors for developing POAMI. In contrast, factors such as sex, body mass index, preoperative coronary artery disease, preoperative stroke/transient ischemic attack, and preoperative statin intake were not associated with POAMI.

Citation: Chang Y, Zhou M, Huang J, Wang Y, Shao J (2023) Incidence and risk factors of postoperative acute myocardial injury in noncardiac patients: A systematic review and meta-analysis. PLoS ONE 18(6): e0286431.

Editor: Seunghwa Lee, Wiltse Memorial Hospital, REPUBLIC OF KOREA

Received: March 9, 2023; Accepted: May 16, 2023; Published: June 15, 2023.

Copyright: © 2023 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.