title: Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization.
abstract: OBJECTIVE
  We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery.
  
  
  BACKGROUND
  Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery.
  
  
  METHODS
  The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures.
  
  
  RESULTS
  Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively, p < 0.001).
  
  
  CONCLUSIONS
  Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.
authors.affiliation: Department of Anesthesiology and CCM, The Hebrew University and Hadassah Medical Center, Jerusalem, Israel. gio@cc.huji.ac.il
authors.forename: Giora
authors.initials: G
authors.lastname: Landesberg
authors.forename: Morris
authors.initials: M
authors.lastname: Mosseri
authors.forename: Vadim
authors.initials: V
authors.lastname: Shatz
authors.forename: Inna
authors.initials: I
authors.lastname: Akopnik
authors.forename: Moshe
authors.initials: M
authors.lastname: Bocher
authors.forename: Michael
authors.initials: M
authors.lastname: Mayer
authors.forename: Haim
authors.initials: H
authors.lastname: Anner
authors.forename: Yacov
authors.initials: Y
authors.lastname: Berlatzky
authors.forename: Charles
authors.initials: C
authors.lastname: Weissman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D015415:Biomarkers; D019210:Troponin I