Routine Postoperative Troponin Screening for Myocardial Injury after Noncardiac Surgery (MINS): A Cost-Effectiveness Review

Myocardial injury after noncardiac surgery (MINS), defined by an ischemic elevation of cardiac troponin rather than by symptoms, affects up to 8% of patients aged 55 or older and as many as one in five of those undergoing vascular or hip-fracture surgery. Because most events are asymptomatic, MINS is largely invisible without systematic postoperative troponin measurement, yet its 30-day mortality rises steeply with the degree of troponin elevation — about 3% at 1.5–4.5× the upper reference limit (Roche Elecsys hs-cTnT, 14 ng/L), 9% at 4.5–70×, and 30% above ~70×. This review evaluates whether routine postoperative troponin screening is cost-effective compared with standard care. A structured literature review of cohort studies and randomized trials examined MINS epidemiology, troponin thresholds, screening, treatment, and cost-effectiveness. Screening costs about CAD $1,632 per MINS detected, versus $23,710 per perioperative myocardial infarction, but cost-effectiveness cannot yet be established. The evidence establishes troponin surveillance as a proven prognostic tool but not yet a proven management strategy. It reliably identifies patients at high cardiac risk, yet no randomized trial has shown that acting on the result improves outcomes. Because effective strategies for primary prevention remain limited, detection and the secondary prevention it enables may provide an important opportunity for risk modification. Targeted surveillance is reasonable in defined high-risk populations, but only where a defined management pathway is already in place. A randomized trial of surveillance plus response versus usual care is the essential next step.