Jesse Manunga, Manju Kalra, Ramoncito David, Gustavo S. Oderich, Audra A. Duncan, Thomas C. Bower, Mark D. Fleming, William (Scott) Harmsen, Peter GloviczkiSurgery, Division of Vascular Surgery, Mayo Clinic, Rochester, Rochester, MN.
To determine the utility of routine post-operative troponin (PO Tn) measurements in patients undergoing major vascular surgical reconstructions (VSRs).
METHODS: Data from consecutive patients undergoing VSRs and routine PO Tn measurement over one year, Jan. 1, 2010, to Dec. 31, 2010, were retrospectively analyzed. A positive troponin (Tn) panel included a baseline level immediately after the procedure of ≥0.20 ng/mL, or a delta at 3 and/or 6 hours of ≥0.30ng/mL / ≥ 20%. Patients without complete Tn panels and research authorization were excluded. Cox Proportional hazards model was used to evaluate the effect of pre-operative risk factors and post-operative Tn levels on early and mid-term mortality.
RESULTS: Of 725 patients undergoing VSRs, 678 (462 males, 216 females; mean age 69 years) satisfied criteria for inclusion. Procedures included 408 open, 196 endovascular and 73 hybrid (306 abdominal, 197 infrainguinal, 40 thoracoabdominal, 117 cerebrovascular and 18 upper extremity). Tn levels were elevated in 67 patients (10%, M: 42, F: 25) and after consultation with a cardiologist were ascribed to non-ST elevation myocardial infarction (NSTEMI) in 26, STEMI in 6, demand ischemia in 29 and renal insufficiency in 6. Sixty-one patients were managed medically; 6 underwent cardiac catheterization and intervention. Thirty-day mortality was significantly higher in Tn+ compared to Tn- patients (7.6% vs 1.7%, p=0.08). On multivariate analysis abnormal delta Tn (p= 0.008, HR= 2.0, 95% CI 1.2-3.4) and SVS/AAVS co-morbidity score >9 were associated with mortality. The cumulative probability of death in Tn+ patients remained significantly higher at 1 (27.6% vs 10.6%, p=0.004) and 2 years (40.8% vs 18.5%, p=0.002).
CONCLUSIONS: Elevated delta troponin levels following major vascular surgical procedures are independently associated with higher 30-day and mid-term mortality, and this marker should be considered an important prognostic indicator.
AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; R. David: Nothing to disclose; A. A. Duncan: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; W. Harmsen: Nothing to disclose; M. Kalra: Nothing to disclose; J. Manunga: Nothing to disclose; G. S. Oderich: Nothing to disclose.
Posted April 2013