JACC Asia · Mar 14, 2026

Association Between Cardiovascular-Kidney-Metabolic Syndrome and Myocardial Injury After Noncardiac Surgery: A Retrospective Cohort Study

By Liao G, Zhang K, Peng J et al.

BACKGROUND: Cardiovascular-kidney-metabolic (CKM) syndrome represents a complex interplay among obesity, metabolic dysfunction, kidney disease, and cardiovascular disease. The relationship between CKM staging and myocardial injury after noncardiac surgery (MINS) has not been comprehensively studied. OBJECTIVES: This study sought to investigate the association between the CKM syndrome and MINS risk in patients undergoing noncardiac surgery. METHODS: This single-center retrospective cohort study included 25,040 patients aged ≥45 years who underwent noncardiac surgery between January 2019 and December 2023. Patients were classified according to CKM stages 0 to 4. MINS was defined as postoperative troponin elevation with ischemic etiology within 30 days. Four progressive multivariable logistic regression models were constructed, and subgroup analyses were performed stratified by age, sex, and surgery type. RESULTS: Among 25,040 patients (median time to MINS: 2.0 days [IQR: 0.8-6.6]), CKM stages 0 to 4 comprised 13.0%, 15.0%, 43.7%, 18.7%, and 9.7%, respectively. MINS occurred in 1,782 patients (7.12% [6.80-7.44]), demonstrating a J-shaped distribution: lowest in stage 1 at 141 of 3,754 (3.76% [3.19-4.41]), intermediate in stages 0 (166 of 3,246, 5.11% [4.40-5.93]) and 2 (586 of 10,943, 5.36% [4.94-5.80]), and highest in stages 3 (512 of 4,670, 10.96% [10.09-11.90]) and 4 (377 of 2,427, 15.53% [14.14-17.04]). With stage 0 as reference, stages 3 (OR: 1.95 [1.60-2.37]) and 4 (OR: 2.16 [1.75-2.66]) independently predicted increased MINS risk (both P < 0.001), with significant age interaction (P = 0.013) showing stronger associations in younger patients. CONCLUSIONS: Advanced CKM stages independently predicted an increased risk of MINS. These findings may improve perioperative risk assessment and guide preventive strategies.

doi.org/10.1016/j.jacasi.2026.01.023Open accessPubMed 41830942Biomarkers