title: Impact of glomerular filtration rate on minor troponin T elevations for risk assessment in patients undergoing operation for abdominal aortic aneurysm or lower extremity arterial obstruction.
abstract: Debate surrounds the impact of renal function on the prognostic value of minor troponin T release in vascular surgery patients. The objective of this study was to assess the long-term prognostic value of minor degrees of troponin T release in patients who undergo major vascular surgery, especially those with concomitant renal dysfunction. Survivors of major noncardiac vascular surgery (n = 558) were preoperatively screened for cardiac risk factors and renal function. Serial troponin T was measured on days 1, 3, and 7 after surgery, using a threshold of 0.03 ng/ml. All-cause mortality and major adverse cardiac events (MACEs) were noted during follow-up (mean 3.5 +/- 2.0 years). Minor (0.03 to 0.09 ng/ml) and major (> or =0.1 ng/ml) release of troponin T was observed in 5% and 8%, respectively. During follow-up, 21% of the patients died and 15% experienced MACEs. After adjustment for the estimated glomerular filtration rate, patients with minor and major troponin T release were at comparable increased risk for late mortality (hazard ratio [HR] 3.43, 95% confidence interval [CI] 1.79 to 6.58, and HR 3.72, 95% CI 2.37 to 5.85, respectively), and MACEs (HR 5.47, 95% CI 2.60 to 11.48, and HR 6.32, 95% CI 3.82 to 10.48, respectively) compared with patients with troponin T release <0.03 ng/ml. Tests for heterogeneity revealed that minor and major troponin T release have prognostic value across the entire spectrum of renal function. In conclusion, marginal elevations of troponin T strongly predict late mortality and MACEs after major vascular surgery, irrespective of renal function. A currently underestimated high-risk subgroup of patients may be identified using a lower troponin T threshold.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Robert
authors.initials: R
authors.lastname: de Jonge
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Martin
authors.initials: M
authors.lastname: Dunkelgrun
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T