title: Cardiac troponin I after carotid endarterectomy in different cardiac risk patients.
abstract: BACKGROUND
  We compared postoperative cardiac damage, defined as cardiac troponin I (cTnI) elevation, in low, medium, and high cardiac risk patients, after carotid endarterectomy (CEA).
  
  
  METHODS
  The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) criteria for stratifying patients considered for vascular surgery into low, medium, and high cardiac risk groups were used prospectively. For all patients (n = 324), cTnI value assessments were made before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from .05 to .5 ng/mL were classified as myocardial ischemia; values more than .5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction.
  
  
  RESULTS
  Mortality was .003%, stroke rate was null, and symptomatic myocardial infarction was null as well. Low-risk patients (16 of 140) and medium-risk patients (28 of 160) increased their troponin levels on days 1 and 3 postoperatively. However, none of the high-risk patients (n = 24) showed any postoperative cardiac damage. Low and medium cardiac risk patients showed higher troponin values on each separate day, in comparison with high cardiac risk patients.
  
  
  CONCLUSIONS
  CEA is followed by a high incidence of asymptomatic cTnI increase that is associated with late cardiac events. However, high cardiac risk patients as defined by the VSG-CRI criteria do not seem to suffer higher cardiac damage after CEA compared with low and medium cardiac risk patients.
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece. Electronic address: georgegalyfos@hotmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Galyfos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Theodorou
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Katsaragakis
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Zografos
authors.affiliation: First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Filis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Cardiac damage; cardiac risk index; cardiac troponin I; carotid endarterectomy