title: Perioperative myocardial injury and hemostasis in patients undergoing endovascular aneurysm repair for asymptomatic infrarenal abdominal aortic aneurysm.
abstract: OBJECTIVE
  (1) To report the incidence of myocardial injury in patients undergoing endovascular aortic aneurysm repair (EVAR) through the routine measurement of perioperative cardiac troponin-T (cTnT) and (2) to investigate and correlate changes in perioperative cTnT levels with any concomitant hemostatic derangement.
  
  
  METHODS
  Prospective study of 30 patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm. Cardiac TnT was assayed at 24 hours postoperatively. Plasma thrombin antithrombin III complex (TAT), plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) activity, and soluble P-selectin (sP-selectin) were assayed preoperatively and at 24 hours postoperatively.
  
  
  RESULTS
  Five (17%) patients demonstrated elevated cTnT levels at 24 hours; 3 patients had no clinical evidence of myocardial injury. There was a positive correlation between cTnT and TAT levels at 24 hours post-EVAR (r = .38, P = .039, Kendall-tau B = 0.26).
  
  
  CONCLUSIONS
  Endovascular aortic aneurysm repair is associated with a significant risk of perioperative myocardial injury that is underdetected clinically and associated with a procoagulopathic state.
authors.affiliation: University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK. rsmdavies@mac.com
authors.forename: Robert S M
authors.initials: RS
authors.lastname: Davies
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelhamid
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Vohra
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Bradbury
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Adam
mesh_terms: D000990:Antithrombin III; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects*; D004739:England; D006335:Heart Injuries / Q000097:blood / Q000209:etiology*; D006487:Hemostasis; D006801:Humans; D015994:Incidence; D019007:P-Selectin / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000097:blood; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019007:P-Selectin; D017395:Plasminogen Activator Inhibitor 1; C546937:SELP protein, human; C051321:SERPINE1 protein, human; D020107:Troponin T; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator