Cardiac troponin I assessment and late cardiac complications after carotid stenting or endarterectomy.
OBJECTIVE
When compared with carotid endarterectomy (CEA), percutaneous carotid angioplasty with stent replacement (CAS) is a less invasive technique in the treatment of carotid stenosis. However, periprocedural hemodynamic instability still remains a challenge. This instability might lead to myocardial damage, which is now measured accurately by using cardiac troponin I (CTnI).


METHODS
This study was designed to compare the periprocedural variation of CTnI in 150 consecutive patients scheduled to undergo CEA (n = 75) or CAS (n = 75). The levels of CTnI were measured until the third postoperative day in all patients. Short-term (1 month) and long-term (up to 5 years) postoperative cardiac outcome were assessed by means of chart review, regular follow-ups, and telephone calls.


RESULTS
There was not any statistically significant difference between the 2 groups regarding the demographic characteristics and preprocedural medical status. The incidence of increase of CTnI (>0.5 ng/mL) was significantly higher in the CEA group (13%) compared with that in the CAS group (1%; P = .001). During the acute postprocedural period, the CAS group was significantly more prone to hypotension, requiring vasopressor therapy, whereas the CEA group had more hypertension, necessitating hypotensive medications (P < .001). At 5 years, the overall incidence of major cardiac complications (nonfatal myocardial infarction and death related to cardiac origin) was significantly more frequent in the CEA group (20% vs 5%, P < .01).


CONCLUSIONS
The results of our study suggest that CAS yielded less myocardial damage in the short and long term when compared with CEA. Larger randomized multicenter trials with long-term outcomes are necessary to confirm our findings.
Motamed
Cyrus
C
Department of Anesthesiology and Intensive Care, Hospital Henri-Mondor, Créteil, France.
Motamed-Kazerounian
Gita
G
Merle
Jean Claude
JC
Dumérat
Marc
M
Yakhou
Leila
L
Vodinh
Jocelyne
J
Kouyoumoudjian
Christian
C
Duvaldestin
Philippe
P
Becquemin
Jean Pierre
JP
D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D016893:Carotid Stenosis / Q000378:metabolism / Q000601:surgery*; D004562:Electrocardiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D015200:Fluoroimmunoassay; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000378:metabolism* / Q000401:mortality; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D019210:Troponin I / Q000378:metabolism*
D015415:Biomarkers; D019210:Troponin I