title: Peak postoperative troponin levels outperform preoperative cardiac risk indices as predictors of long-term mortality after vascular surgery Troponins and postoperative outcomes.
abstract: BACKGROUND
  The utility of postoperative troponins as an independent predictor of long-term mortality after vascular surgery is unknown.
  
  
  METHODS
  One hundred sixty-four consecutive patients underwent vascular surgery and postoperative mortality was determined at 2.5 years. Troponins were drawn within 48 hours postsurgery and the peak levels, defined by the upper reference limit (URL), were categorized as negative (<URL), low positive (≥URL but <3 times the URL), or high positive (≥ 3 times the URL). A logistic regression model comprised all univariate predictors of long-term mortality and included peak troponin levels and the number of the preoperative revised cardiac risks.
  
  
  RESULTS
  Mortality in the high positive (n = 44), low positive (n = 41), and negative (n = 79) troponin groups was 46%, 17%, and 6%, respectively (P < .05). Independent predictors of long-term mortality were peak postoperative troponins (odds ratio [OR], 8.85; 95% confidence interval [CI], 3.29-23.81; P < .001), tissue loss (OR, 2.87; 95% CI, 1.03-8.00; P = .043), and use of statins (OR, 0.19; 95% CI, 0.07-0.49; P < .001). The c index for peak troponin levels was 0.75 (95% CI, 0.68-0.82; P < .01) and outperformed the Revised Cardiac Risk Index for predicting long-term outcomes.
  
  
  CONCLUSIONS
  Among patients undergoing vascular surgery, an elevated postoperative troponin level provides incremental value in predicting long-term outcomes, when compared with standard preoperative cardiac and surgical risks.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55417, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Marston
authors.forename: Jorge
authors.initials: J
authors.lastname: Brenes
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Michael
authors.initials: M
authors.lastname: Kuskowski
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.forename: Steven
authors.initials: S
authors.lastname: Santilli
authors.forename: Edward O
authors.initials: EO
authors.lastname: McFalls
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000401:mortality*
chemical_list: D015415:Biomarkers; D014336:Troponin