title: Prognostic value of 12-lead electrocardiogram and peak troponin I level after vascular surgery.
abstract: OBJECTIVE
  The aim of this investigation was to determine if the presence of ischemic electrocardiographic (ECG) changes in patients undergoing vascular surgery provides incremental prognostic information about the long-term risk of death compared with a single peak troponin level within 48 hours after surgery.
  
  
  METHODS
  This was a retrospective analysis of 337 patients undergoing moderate-risk to high-risk vascular surgery at our institution whose ECG and biomarker data were complete. Peak cardiac troponin (cTn) I values that exceeded the upper reference limit (URL) were categorized as low-positive (+), at or exceeding the URL but less than three times the URL, or high-positive (+), at or exceeding three times the URL. ECGs were classified as ischemic or nonischemic. The primary outcome was death at 1 year after the vascular operation. Independent predictors of long-term mortality were determined by Cox proportional hazards regression analysis.
  
  
  RESULTS
  The most common vascular problem was an expanding abdominal aortic aneurysm (n=185 [55%]). With regard to cTnI, 53 patients (16%) were classified as high (+) and 82 (24%) as low (+). The ECG in 21 patients (6%) showed evidence of myocardial ischemia. An increase in 1-year mortality of 3% for normal, 11% for low (+), and 17% for high (+) (P<.01) was seen with incremental cTn values. Independent predictors of long-term mortality were age (odds ratio [OR], 1.05, 95% confidence interval [CI], 1.02-1.07; P<.01), stratified troponin (OR, 1.62; 95% CI, 1.25-2.10; P<.01), tissue loss (OR, 3.30; 95% CI, 1.72-6.33; P<.01), stratified Revised Cardiac Risk Index (OR, 1.32; 95% CI, 0.97-1.81; P<.07), and statin use (OR, 0.62; 95% CI, 0.40-0.98; P=.04). The presence of ischemia on ECG was not a predictor of long-term mortality.
  
  
  CONCLUSIONS
  In the presence of an elevated cTn I, the ECG is not an independent predictor of long-term mortality after vascular surgery. These results support a strategy of routine surveillance of cTns after vascular surgery for the detection of cardiac events and postoperative risk stratification.
authors.affiliation: Department of Medicine, Division of Cardiology, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, MN 55417, USA. garci205@umn.edu
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
authors.forename: Nicholas
authors.initials: N
authors.lastname: Marston
authors.forename: Yader
authors.initials: Y
authors.lastname: Sandoval
authors.forename: Gordon
authors.initials: G
authors.lastname: Pierpont
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.forename: Jorge
authors.initials: J
authors.lastname: Brenes
authors.forename: Steven
authors.initials: S
authors.lastname: Santilli
authors.forename: Edward O
authors.initials: EO
authors.lastname: McFalls
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004562:Electrocardiography; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D015415:Biomarkers; D019210:Troponin I