• Vascular Annual Meeting
• Call for Abstracts
• General Information
• Exhibitor Information
• Alumni Association Information
• 2009 Meeting Information
• Future Meeting Dates
• Contact Us

Home > Vascular Annual Meeting > SS20. Asymptomatic Perioperative Myocardial Damage...

SS20. Asymptomatic Perioperative Myocardial Damage Is Associated with Poor Long-Term Outcome After Vascular Surgery

Olaf Schouten1, Tamara A. Winkel1, Gijs M.J.M. Welten1, Hero van Urk1, Hence J.M. Verhagen1, Jeroen J. Bax2, Don Poldermans1
1Erasmus Medical Center Rotterdam, Rotterdam, Netherlands2Leiden University Medical Center, Leiden, Netherlands

OBJECTIVES: Cardiac troponin T (cTnT) release is a sensitive marker for myocardial injury and occurs frequently after vascular surgery. However, the prognosis of cTnT elevations without clinical symptoms and/or new electrocardiographic changes (asymptomatic cTnT release) is unknown. To assess the long-term prognosis of vascular surgery patients who experience perioperative asymptomatic myocardial damage.

METHODS: A total of 1,545 patients undergoing elective vascular surgery were enrolled. Baseline characteristics and medication were noted. Routine sampling of cTnT and ECG recording was performed on day 1, 3, and 7 after surgery and at the day of discharge. Elevated cTnT was defined as serum concentrations ≥0.01 ng/ml. The mean follow-up was 3.7 years and mortality was noted.

RESULTS: A total of 213 (14%) patients experienced asymptomatic cTnT release, median 0.08 ng/ml (IQR 0.04-0.20 ng/ml), while 71 (5%) patients had symptomatic cTnT release. During follow-up 304 patients (20%) died. Mortality was higher in patients with asymptomatic cTnT release compared to patients without cTnT release (13% vs. 40%; p<0.001, figure). After adjustment for risk factors and type and site of surgery, the association between asymptomatic elevated cTnT levels and increased late mortality persisted (adjusted HR 2.3; 95% CI 1.8-3.0) and risk increased with higher cTnT levels (HR 1.64 for every 0.10 ng/ml increase, p=0.02). Elevated cTnT had prognostic value irrespective of baseline creatinine value or renal dysfunction after surgery.

CONCLUSIONS: Asymptomatic cTnT release, without clinical symptoms or new ECG changes, is associated with an increased long-term mortality in patients undergoing vascular surgery.

AUTHOR DISCLOSURES: O. Schouten, None; T.A. Winkel, None; G.M. Welten, None; H. van Urk, None; H.J.M. Verhagen, None; J.J. Bax, None; D. Poldermans, None.

Figure 1.