Jessica P. Simons1, Donald Baril1, Philip P. Goodney2, Nathanael D. Hevelone3, Daniel J. Bertges4, Virendra I. Patel5, William P. Robinson1, Jack L. Cronenwett2, Louis M. Messina1, Andres Schanzer1
1Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MA; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Harvard School of Public Health, Boston, MA; 4University of Vermont College of Medicine, Burlington, VT; 5Massachusetts General Hospital, Boston, MA.
OBJECTIVES: The impact of postoperative troponin elevation on long-term survival after vascular surgery is not well-defined. We hypothesize that a troponin elevation is associated with reduced long-term survival.
METHODS: The VSGNE identified all patients who underwent carotid revascularization, open AAA repair, endovascular AAA repair or infrainguinal lower extremity bypass (2003-2011). The effect of postoperative troponin elevation and myocardial infarction (MI) on 5-year survival was evaluated using Kaplan Meier analysis and Cox Proportional Hazards models.
RESULTS: In 16,363 patients, the incidence of postoperative troponin elevation and MI were 1.3% (n=211) and 1.6% (n=264), respectively. Both were associated with reduced 5-year survival: no ischemia, 73%; troponin elevation, 54%; MI, 33% (p<0.0001). This pattern was observed for each procedure subgroup analysis (p<0.0001). Troponin elevation (HR 1.45, 95% CI 1.1-2.0, p=0.02) and MI (HR 2.9, 95% CI 2.3-3.8, p<0.0001) were independent predictors of reduced 5-year survival.
CONCLUSIONS: Postoperative troponin elevation and MI predict 26% and 55% lower 5-year survival, respectively, after vascular procedures compared with no myocardial ischemia. This highlights the need to better characterize factors leading to postoperative myocardial ischemia. Postoperative troponin elevation alone is a marker for high-risk patients who might benefit from more aggressive cardiac optimization.
AUTHOR DISCLOSURES: D. Baril:
Posted April 2013
Nothing to disclose; D. J. Bertges:
Nothing to disclose; J. L. Cronenwett:
Nothing to disclose; P. P. Goodney:
Nothing to disclose; N. D. Hevelone:
Nothing to disclose; L. M. Messina: Nothing to disclose;
V. I. Patel: Nothing to disclose; W. P. Robinson:
Nothing to disclose; A. Schanzer:
Nothing to disclose; J. P. Simons:
Nothing to disclose.