Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery.
OBJECTIVE
The aim of this study was to determine the long-term prognosis with postoperative markers of myocardial ischemia and infarction.


BACKGROUND
Cardiac troponins (cTn) are superior to creatine kinase-MB fraction (CK-MB) in detecting perioperative myocardial infarction (PMI). However, their threshold levels signifying PMI and their long-term prognostic value are not yet determined.


METHODS
A cohort of 447 consecutive patients who underwent 501 major vascular procedures was prospectively studied. Perioperative continuous 12-lead electrocardiogram monitoring, cardiac troponin-I (cTn-I) and/or cardiac troponin-T (cTn-T), and CK-MB levels on the first three postoperative days, and long-term survival were determined. The association of different cutoff levels of CK-MB, troponin, and ischemia duration with long-term survival was investigated.


RESULTS
Between 14 (2.9%) and 107 (23.9%) of the patients sustained PMI, depending on the biochemical criteria used. Elevated postoperative CK-MB, cTn, and prolonged (>30 min) ischemia, at all cutoff levels examined, predicted long-term mortality independent of the preoperative predictors: patient's age, type of vascular surgery, previous myocardial infarction, and renal failure (Cox multivariate analysis). Both CK-MB >10% and cTn-I >1.5 ng/ml and/or cTn-T >0.1 ng/ml independently predicted a 3.75-fold and 2.06-fold increase in long-term mortality (p = 0.006 and 0.012, respectively). Similarly, both CK-MB >5% and cTn-I >0.6 ng/ml and/or cTn-T >0.03 ng/ml independently predicted a 2.15-fold and 1.89-fold increase in mortality (p = 0.018 and 0.01, respectively). Patients with both these markers elevated had a 4.19-fold increase in mortality (p < 0.001).


CONCLUSIONS
Postoperative CK-MB and troponin, even at low cutoff levels, are independent and complementary predictors of long-term mortality after major vascular surgery.
Landesberg
Giora
G
Department of Anesthesiology, Hadassah Medical Center, Jerusalem, Israel. gio@cc.huji.ac.il
Shatz
Vadim
V
Akopnik
Inna
I
Wolf
Yehuda G
YG
Mayer
Michael
M
Berlatzky
Yacov
Y
Weissman
Charles
C
Mosseri
Morris
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D011184:Postoperative Period; D011446:Prospective Studies; D016019:Survival Analysis; D014336:Troponin / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000401:mortality*
D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form