Cardiac troponin I predicts short-term mortality in vascular surgery patients.
BACKGROUND
Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury that predicts outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who have undergone vascular surgery. However, postoperative surveillance with cardiac enzymes is not routinely performed in these patients. We evaluated the association between postoperative cTnI levels and 6-month mortality and perioperative myocardial infarction (MI) after vascular surgery.


RESULTS
Two hundred twenty-nine patients having aortic or infrainguinal vascular surgery or lower extremity amputation were included in this study. Blood samples were analyzed for cTnI immediately after surgery and the mornings of postoperative days 1, 2, and 3. An elevated cTnI was defined as serum concentrations >1.5 ng/mL in any of the 4 samples. Twenty-eight patients (12%) had postoperative cTnI >1.5 ng/mL, which was associated with a 6-fold increased risk of 6-month mortality (adjusted OR, 5.9; 95% CI, 1.6 to 22.4) and a 27-fold increased risk of MI (OR, 27.1; 95% CI, 5.2 to 142.7). Furthermore, we observed a dose-response relation between cTnI concentration and mortality. Patients with cTnI >3.0 ng/mL had a significantly greater risk of death compared with patients with levels < or =0.35 ng/mL (OR, 4.9; 95% CI, 1.3 to 19.0).


CONCLUSIONS
Routine postoperative surveillance for cTnI is useful for identifying patients who have undergone vascular surgery who have an increased risk for short-term mortality and perioperative MI. Further research is needed to determine whether intervention in these patients can improve outcome.
Kim
Lauren J
LJ
Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, Baltimore, Md 21287-7294, USA.
Martinez
Elizabeth A
EA
Faraday
Nauder
N
Dorman
Todd
T
Fleisher
Lee A
LA
Perler
Bruce A
BA
Williams
G Melville
GM
Chan
Daniel
D
Pronovost
Peter J
PJ
D000368:Aged; D000671:Amputation, Surgical / Q000401:mortality; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism*; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000401:mortality*
D019210:Troponin I