title: Postoperative levels of cardiac troponin versus CK-MB and high-sensitivity C-reactive protein for the prediction of 1-year cardiovascular outcome in patients undergoing vascular surgery.
abstract: OBJECTIVE
  This study evaluated comparatively the predictive value of postoperative cardiac troponin I (cTnI), creatinine kinase (CK)-MB, and high-sensitivity C-reactive protein (hs-CRP) in 1-year cardiovascular mortality and morbidity in patients undergoing elective vascular surgery.
  
  
  METHODS
  A total of 295 consecutive patients undergoing elective noncardiac vascular surgery were prospectively followed-up over a period of 12 months. The levels of cTnI, CK-MB, and hs-CRP were measured preoperatively and 24 h after operation. The primary endpoint was the composite of cardiovascular death, nonfatal acute myocardial infarction, ischemic stroke, and unstable angina.
  
  
  RESULTS
  The primary endpoints occurred in 11 patients (3.8%). Receiver operating characteristic curve analysis showed that postoperative cTnI was a strong predictor of a cardiovascular event during 1-year follow-up (area under the curve, 0.852; P<0.001). Areas under the curve for hs-CRP and for CK-MB were 0.734 (P=0.008) and 0.494 (P=0.947). A threshold cTnI value of 0.4 ng/ml was highly associated with the occurrence of a cardiovascular event, with a sensitivity of 80% and specificity of 81%. Furthermore, cTnI levels provided a significantly better prediction than CK-MB levels (P=0.009) and tended to be superior to hs-CRP (P=0.2).
  
  
  CONCLUSIONS
  Postoperative cTnI levels seem to be superior to CK-MB and hs-CRP levels for the prediction of 1-year cardiovascular mortality and morbidity in patients undergoing elective vascular surgery.
authors: Departments of Surgery-Vascular Surgery Unit, University of Ioannina, Greece.
authors: George N
authors: GN
authors: Kouvelos
authors: Haralampos J
authors: HJ
authors: Milionis
authors: Eleni M
authors: EM
authors: Arnaoutoglou
authors: George
authors: G
authors: Chasiotis
authors: Constantina
authors: C
authors: Gartzonika
authors: Nektario K
authors: NK
authors: Papa
authors: Petros
authors: P
authors: Tzimas
authors: Miltiadis I
authors: MI
authors: Matsagkas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016009:Chi-Square Distribution; D052279:Creatine Kinase, MB Form / Q000097:blood*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D006115:Greece; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form