Diagnosis, Incidence, and Clinical Implications of Perioperative Myocardial Injury in Vascular Surgery.
BACKGROUND
Routine measurement of cardiac biomarkers such as troponin T (TnT) is recommended perioperatively, especially in high-risk vascular surgery. Long-term prognosis is worse even in those with nonspecific perioperative myocardial injury. However, a clear understanding of these biomarker profiles and how they should affect patient management is lacking.


METHODS
We examined the perioperative profile of high-sensitivity TnT (hsTnT) release in 85 patients undergoing elective major vascular surgery. Plasma hsTnT was measured preoperatively, at 6, 12, and 24 hours postoperatively, and then every 24 hours for a maximum of 5 days. Significant elevations in hsTnT with/without clinical indicators of ischemia were used to diagnose myocardial infarction or injury.


RESULTS
A high incidence of myocardial injury was evident (46% had elevated hsTnT); only 5% were associated with myocardial infarction, and 41% were due to myocardial injury.


CONCLUSIONS
This study emphasizes the high incidence of perioperative myocardial injury and stress in vascular surgery as revealed by the use of the robust and very sensitive biomarker of myocardial damage, hsTnT. The high availability and swift development of increasingly sensitive assays allow detection of abnormal elevated hsTnT levels in a higher proportion of the population. Consequent challenges are the reduced specificity to separate acute events as well as to deduce the prognostic value of elevations due to confusing criteria; this is especially the case in a patient group with multiple comorbidities that affect hsTnT levels chronically.
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
Kate N
KN
Thomas
School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.
James D
JD
Cotter
Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Michael J A
MJ
Williams
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand andre.vanrij@otago.ac.nz.
André M
AM
van Rij
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D015415:Biomarkers; D020107:Troponin T
biomarkers; myocardial injury; troponin T