# Myocardial Injury After Non-Cardiac Surgery in Otolaryngology: Evidence Gaps and a Systematic Review

## TL;DR

Myocardial injury after non-cardiac surgery is a serious but underrecognized complication, especially in otolaryngology, where it lacks clear management guidelines.

## Contribution

This systematic review highlights evidence gaps and the need for specialty-specific guidelines for managing myocardial injury in otolaryngology.

## Key findings

- Troponin monitoring is the gold standard for diagnosing myocardial injury after non-cardiac surgery.
- Controlled hypotension in otolaryngology procedures may increase the risk of myocardial injury.
- Current evidence on myocardial injury in otolaryngology is limited and lacks standardized management guidelines.

## Abstract

Background/Objectives: Myocardial injury after non-cardiac surgery (MINS) is a common and serious postoperative complication. Its largely asymptomatic course hampers early recognition, highlighting the importance of systematic biomarker monitoring. The aim of this review is to summarize current evidence on the diagnosis, risk factors, and management of MINS, with a focus on otolaryngology, where intraoperative hypotensive techniques may increase risk. Methods: A basic science review was conducted using PubMed, Embase, and the Cochrane Library (2005–2025). From 2712 records, 30 studies met the inclusion criteria after removing duplicates, screening titles/abstracts, and full-text assessment. These studies formed the basis for the final analysis. Results: Observational studies and reviews identify perioperative troponin monitoring as the diagnostic gold standard. However, no evidence-based management guidelines exist, and otorhinolaryngology-specific data remain rare but not entirely absent. Troponin elevation in the early postoperative period reliably predicts adverse outcomes. While MINS is well documented in vascular and orthopedic surgery, evidence in otolaryngology is limited. Controlled hypotension in procedures such as functional endoscopic sinus surgery or head and neck tumor resection may further elevate risk. Conclusions: MINS is an underrecognized complication with major prognostic significance. The lack of standardized management and the absence of large otolaryngology cohorts underscore an urgent need for targeted research and specialty-specific guidelines and support the justification for integrating existing evidence into otolaryngologic practice.