title: Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm: a retrospective population-based cohort study.
abstract: BACKGROUND
  Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes.
  
  
  METHODS
  This was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair.
  
  
  RESULTS
  In total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007).
  
  
  CONCLUSIONS
  Elevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.
authors.forename: Ilana
authors.initials: I
authors.lastname: Kopolovic
authors.forename: Kimberley
authors.initials: K
authors.lastname: Simmonds
authors.forename: Shelley
authors.initials: S
authors.lastname: Duggan
authors.forename: Mark
authors.initials: M
authors.lastname: Ewanchuk
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Stollery
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D014463:Ultrasonography
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D019210:Troponin I