title: Frequency of Increase in Cardiac Troponin Levels After Peripheral Arterial Operations (Carotid Endarterectomy, Abdominal Aorta Procedure, Distal Bypass) and Their Effect on Medical Management.
abstract: The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant. Intensification of medical therapy was defined as initiation of aspirin or initiation or increases in the dose of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers, statins, or β blockers and was left to the discretion of treating physicians. From June 2011 to April 2015, a total of 185 patients (mean age 68 ± 7 years, 100% men) were enrolled in the trial. A total of 28 patients (15%) had significant increases in cTnI after vascular surgery, and 38 (20.5%) had their medical therapies intensified in the perioperative period. Among patients with increases in cTnI, 11 (39%) had intensification of medical therapy versus 27 patients (17%) with no or smaller increases in cTnI (p = 0.02). Among those patients with ΔcTnI ≥0.01 μg/l, hospital readmissions at 3 to 6 months were 7.6% for the intensification group versus 25% for the no intensification group (p = 0.18). Mortality rate at 6 months was low in both groups (2.6% vs 0%, respectively, p = 0.13). In conclusion, among patients undergoing vascular surgery, perioperative increases in cTn were associated with initiation or intensification of medical therapies for coronary artery disease at the time of discharge.
authors.affiliation: Division of Cardiology, Department of Medicine, Hennepin County Medical Center and Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Yader
authors.initials: Y
authors.lastname: Sandoval
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Marina
authors.initials: M
authors.lastname: Zakharova
authors.affiliation: Department of Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Rector
authors.affiliation: Division of Cardiology, Department of Medicine, Dallas VA Medical Center, Dallas, Texas; Division of Cardiology, Department of Medicine, UT Southwestern University, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Todd
authors.initials: T
authors.lastname: Drexel
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota.
authors.forename: Edward O
authors.initials: EO
authors.lastname: McFalls
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota. Electronic address: garci205@umn.edu.
authors.forename: Santiago
authors.initials: S
authors.lastname: Garcia
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000097:blood*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood*; D015995:Prevalence; D012189:Retrospective Studies; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood*; D014656:Vascular Surgical Procedures
chemical_list: D019210:Troponin I