Perioperative medicine & outcomes
Autonomic Vulnerability, Intraoperative Hypotension Burden, and Myocardial Injury After Noncardiac Surgery in Older Adults: A Propensity Score-Matched Retrospective Cohort Study
Main finding · Adjudicated ischemic MINSResult — go to the resultOdds ratio 1.75 95% CI 1.23–2.49Authors' conclusion
In older adults undergoing major noncardiac surgery, a preoperative electronic health record-based autonomic vulnerability phenotype was associated with higher risk of adjudicated ischemic MINS, and this association was stronger at higher IOH burden.
Study context
- Population
- Patients aged ≥65 years undergoing major noncardiac surgery with perioperative high-sensitivity cardiac troponin T (hs-cTnT) surveillance612 matched pairs analysed
- Participants
- 2,184 patients
- Exposure
- Autonomic vulnerability phenotype vs control
- Autonomic vulnerabilityn = 612
- Controln = 612reference
- Outcome
- Adjudicated ischemic MINS
Methodological detailssingle-centre, propensity-score matched (1:1)
- Single-centre
- Propensity-score matched (1:1)
Main finding
As reported in the abstract
Odds ratio
1.75
95% CI 1.23–2.49
P = 0.002
Events by group
Autonomic vulnerability vs Control
OR 1.75 (95% CI 1.23–2.49); P = 0.002
Observational data: associations, not effects.
Secondary outcomes
Postoperative hs-cTnT elevation
- OR
- 1.63 (95% CI 1.28-2.07; P < .001)
- More frequent with autonomic vulnerability (27.1% vs 18.5%)
- Propensity-matched cohort
30-day major adverse cardiac events (MACE)
- Increased with autonomic vulnerability; HR
- 1.68 (95% CI 1.12-2.51; P = .012)
1-year all-cause mortality
- Increased with autonomic vulnerability; HR
- 1.54 (95% CI 1.07-2.22; P = .020)
Intraoperative hypotension (IOH) effect modification of autonomic vulnerability-MINS association
- Highest IOH quartile OR
- 2.84 (95% CI 1.62-4.97; P < .001)
- IOH burden modified the association (P for interaction = .018)
Original publication
Autonomic Vulnerability, Intraoperative Hypotension Burden, and Myocardial Injury After Noncardiac Surgery in Older Adults: A Propensity Score-Matched Retrospective Cohort Study. Anesth Analg. Published 1 September 2026. doi:10.
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