Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm: a retrospective population-based cohort study

• Published in: Critical care (London, England) England), 2012-08, Vol.16 (4), p.R147-R147, Article R147
• Main Authors: Kopolovic, Ilana, Simmonds, Kimberley, Duggan, Shelley, Ewanchuk, Mark, Stollery, Daniel E, Bagshaw, Sean M
• Format: Article
• Language: English
• Subjects: Abdominal aneurysm; Adrenergic beta-Antagonists - therapeutic use; Aged; Analysis; Aneurysms; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Biomarkers - blood; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - etiology; Care and treatment; Complications and side effects; Coronary Disease - complications; Coronary Disease - drug therapy; Coronary heart disease; Electrocardiogram; Electrocardiography; Female; Heart - physiopathology; Hospital Mortality; Humans; Hypertension - complications; Hypertension - drug therapy; Intensive Care Units; Length of Stay; Male; Measurement; Mortality; Patient outcomes; Physiological aspects; Postoperative Complications - diagnostic imaging; Postoperative Period; Retrospective Studies; Risk Factors; Troponin I - blood; Ultrasonography
• ISSN: 1364-8535; 1466-609X; 1364-8535
• DOI: 10.1186/cc11461

Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes. This was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair. In total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007). Elevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.