We read with interest the May 2017 ASA Monitor article written by Ken Pauker, M.D., and colleagues regarding the association of increased postoperative troponin with non-cardiac surgery, myocardial injury (MINS) and increased 30-day mortality. While the authors describe Type I myocardial injury as being caused by coronary occlusion secondary to a thrombosis or plaque rupture, and Type II myocardial injury caused by a mismatch of myocardial oxygen supply and demand, they don’t offer much guidance on how we can reduce the incidence of MINS.

Over the last few decades, several seemingly minor clinical strategies have been shown to decrease perioperative complications. Examples include the use of beta-blockers in patients at high risk of coronary disease to decrease the incidence of perioperative cardiac ischemia (e.g., ST-segment depression) and cardiac mortality rate.3-5  In patients who are...

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