Elevated postoperative CK-MB and cardiac troponin independently predicted long-term mortality after major vascular surgery, with a 4.19-fold increase in mortality when both were elevated (p<0.001).
Cohort (n=447)
Does postoperative elevation of cardiac troponin, CK-MB, or myocardial ischemia predict long-term mortality in patients undergoing major vascular surgery?
Postoperative elevations in CK-MB and cardiac troponin, even at low thresholds, are independent and complementary predictors of long-term mortality after major vascular surgery.
Estimación del efecto: HR 4.19
valor p: p=<0.001
OBJECTIVES: The aim of this study was to determine the long-term prognosis with postoperative markers of myocardial ischemia and infarction. BACKGROUND: Cardiac troponins (cTn) are superior to creatine kinase-MB fraction (CK-MB) in detecting perioperative myocardial infarction (PMI). However, their threshold levels signifying PMI and their long-term prognostic value are not yet determined. METHODS: A cohort of 447 consecutive patients who underwent 501 major vascular procedures was prospectively studied. Perioperative continuous 12-lead electrocardiogram monitoring, cardiac troponin-I (cTn-I) and/or cardiac troponin-T (cTn-T), and CK-MB levels on the first three postoperative days, and long-term survival were determined. The association of different cutoff levels of CK-MB, troponin, and ischemia duration with long-term survival was investigated. RESULTS: Between 14 (2.9%) and 107 (23.9%) of the patients sustained PMI, depending on the biochemical criteria used. Elevated postoperative CK-MB, cTn, and prolonged (>30 min) ischemia, at all cutoff levels examined, predicted long-term mortality independent of the preoperative predictors: patient's age, type of vascular surgery, previous myocardial infarction, and renal failure (Cox multivariate analysis). Both CK-MB >10% and cTn-I >1.5 ng/ml and/or cTn-T >0.1 ng/ml independently predicted a 3.75-fold and 2.06-fold increase in long-term mortality (p = 0.006 and 0.012, respectively). Similarly, both CK-MB >5% and cTn-I >0.6 ng/ml and/or cTn-T >0.03 ng/ml independently predicted a 2.15-fold and 1.89-fold increase in mortality (p = 0.018 and 0.01, respectively). Patients with both these markers elevated had a 4.19-fold increase in mortality (p < 0.001). CONCLUSIONS: Postoperative CK-MB and troponin, even at low cutoff levels, are independent and complementary predictors of long-term mortality after major vascular surgery.
Landesberg et al. (Sat,) conducted a cohort in Major vascular surgery (n=447). Elevated postoperative CK-MB and cardiac troponin vs. Normal levels was evaluated on Long-term mortality (HR 4.19, p=<0.001). Elevated postoperative CK-MB and cardiac troponin independently predicted long-term mortality after major vascular surgery, with a 4.19-fold increase in mortality when both were elevated (p<0.001).