Should troponin and creatinine kinase be routinely measured after vascular surgery?
The current guidelines for the evaluation and prediction of adverse cardiovascular events (CVEs) following vascular surgery in high-risk patients recommends serial electrocardiograms (ECGs) but not biomarkers such as cTn-I and CK-MB. The objective of this study was to determine whether biomarkers should be routinely measured in high-risk patients undergoing vascular surgery. A multicenter, prospective study with investigators blinded to core laboratory results was conducted. cTn-I and CK-MB were obtained on the day of surgery, as well as 24 hours, 72 hours and 120 hours after surgery, 24 hours prior to planned hospital discharge and at the onset of symptoms of a suspected CVE. The CVE was adjudicated by an endpoint committee using ECG, biomarker and symptoms data and was defined as cardiac death or myocardial infarction (MI) occurring up to 30 days after surgery. A total of 784 patients, with a mean age of 70.1 (SD +/- 9.8), underwent vascular surgery. Of the 83 patients with a CVE, cTn-I was positive in 42 and CK-MB was positive in 29 on or before the day of the CVE. The number of patients not classified as having a CVE but positive for elevation of cTn-I or CK-MB was 64 and 20, respectively. cTn-I was more sensitive than CK-MB (50.6% versus 34.9%) for predicting a CVE. The optimum time for measuring cTn-I after surgery with the highest positive predictive value was 24 hours. In conclusion, these data support routine serial measurement of cTn-I after vascular surgery.
Mohler
Emile R
ER
University of Pennsylvania School of Medicine, Philadelphia, PA, USA. mohlere@uphs.upenn.edu
Mantha
Srinivas
S
Miller
Alan B
AB
Poldermans
Don
D
Cropp
Anne B
AB
St Aubin
Lisa B
LB
Billing
Clare B
CB
Fleisher
Lee A
LA
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014336:Troponin / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D015415:Biomarkers; D014336:Troponin; D052279:Creatine Kinase, MB Form