Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization

• Published in: Journal of the American College of Cardiology 2004-08, Vol.44 (3), p.569-575
• Main Authors: Landesberg, Giora, Mosseri, Morris, Shatz, Vadim, Akopnik, Inna, Bocher, Moshe, Mayer, Michael, Anner, Haim, Berlatzky, Yacov, Weissman, Charles
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Biomarkers - blood; Cardiology; Coronary vessels; Female; Heart attacks; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction - complications; Myocardial Ischemia - blood; Myocardial Ischemia - complications; Myocardial Revascularization; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Troponin I - blood; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.03.073

We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively, p < 0.001). Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.