Perioperative myocardial injury after elective open abdominal aortic aneurysm repair predicts outcome.
OBJECTIVE
Myocardial injury, detected by rises in cardiac troponin I (TnI), is common and associated with decreased survival following open AAA surgery. We examined the relationship between perioperative myocardial injury and postoperative outcome.


METHODS
Observational Cohort Study.


METHODS
Forty-three consecutive patients who underwent elective open AAA repair were screened for perioperative myocardial injury or infarction using serial TnI measurements (taken on days 1, 3, and 7), ECG and clinical assessment. The primary outcome was survival free of cardiac failure, or myocardial infarction (MI) at follow-up.


RESULTS
Twenty (47%) of the 43 patients had a TnI elevation. Of these, 11 (26%) patients met the criteria for MI. At a mean (+/-SD) follow-up of 1.5+/-0.8 years, 12 (28%) subjects had experienced at least one endpoint event. Survival free of cardiac failure or MI was 55% in patients who had TnI rises compared to 87% in those without (P=0.02). Logistic regression revealed that TnI elevation was an independent predictor of outcome with an odds ratio of 5.4 (95% CI 1.2-2.4, P=0.03).


CONCLUSIONS
Perioperative myocardial injury after elective open AAA repair predicts outcome after surgery. Routine TnI measurement should be considered in all patients, especially in those with high cardiovascular risk.
Cambridge Cardiovascular Unit, Addenbrooke's Hospital, Cambridge, UK.
Z A
ZA
Ali
C J
CJ
Callaghan
A A
AA
Ali
A Y
AY
Sheikh
A
A
Akhtar
A
A
Pavlovic
S A Reza
SA
Nouraei
D P
DP
Dutka
M E
ME
Gaunt
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000150:complications / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000209:etiology*; D006335:Heart Injuries / Q000097:blood / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D019210:Troponin I