TY - JOUR
T1 - Cardiac troponin after major vascular surgery
T2 - The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization
AU - Landesberg, Giora
AU - Mosseri, Morris
AU - Shatz, Vadim
AU - Akopnik, Inna
AU - Bocher, Moshe
AU - Mayer, Michael
AU - Anner, Haim
AU - Berlatzky, Yacov
AU - Weissman, Charles
PY - 2004/8/4
Y1 - 2004/8/4
N2 - Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.
AB - Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.
KW - CABG
KW - CAD
KW - CK-MB
KW - MI
KW - OR
KW - PCI
KW - PTS
KW - cTn
KW - cardiac troponin
KW - coronary artery bypass graft surgery
KW - coronary artery disease
KW - creatine kinase-MB fraction
KW - myocardial infarction
KW - odds ratio
KW - percutaneous coronary intervention
KW - preoperative thallium scanning
UR - http://www.scopus.com/inward/record.url?scp=4043153566&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2004.03.073
DO - 10.1016/j.jacc.2004.03.073
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C2 - 15358022
AN - SCOPUS:4043153566
SN - 0735-1097
VL - 44
SP - 569
EP - 575
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 3
ER -