Abnormal postoperative cTnI occurred in 14% of patients after abdominal aortic surgery, with in-hospital mortality rates of 24% for early PMI, 21% for delayed PMI, and 3% for normal cTnI.
Cohort (n=1,136)
Postoperative myocardial infarction after abdominal aortic surgery presents as early or delayed types with distinct cTnI profiles, both of which are associated with high in-hospital mortality (>20%).
BACKGROUND: Although postoperative myocardial infarction (PMI) after vascular surgery has been described to be associated with prolonged ischemia, its exact pathophysiology remains unclear. METHODS: The authors used intense cardiac troponin I (cTnI) surveillance after abdominal aortic surgery in 1,136 consecutive patients to better evaluate the incidence and timing of PMI (cTnI > or = 1.5 ng/ml) or myocardial damage (abnormal cTnI 24 h) period of increased cTnI (delayed PMI), and in 21 patients (2%), the increase in cTnI lasted less than 24 h (early PMI). The mean times from end of surgery to PMI were 37 +/- 22 and 74 +/- 39 h in the early PMI and delayed PMI groups, respectively (P < 0.001). The mean time between the first abnormal cTnI and PMI in the delayed PMI group was 54 +/- 35 h, during which the cTnI profiles of the myocardial damage and delayed PMI groups were identical. In-hospital mortality rates were 24, 21, 7, and 3% for the early PMI, delayed PMI, myocardial damage, and normal groups, respectively. CONCLUSIONS: Intense postoperative cTnI surveillance revealed two types of PMI according to time of appearance and rate of increase in cTnI. The identification of early and delayed PMI may be suggestive of different pathophysiologic mechanisms. Abnormal but low postoperative cTnI is associated with increased mortality and may lead to delayed PMI.
Manach et al. (2005) conducted a cohort in Abdominal aortic surgery (n=1,136). Abnormal postoperative cardiac troponin I (cTnI) vs. Normal cTnI was evaluated on In-hospital mortality. Abnormal postoperative cTnI occurred in 14% of patients after abdominal aortic surgery, with in-hospital mortality rates of 24% for early PMI, 21% for delayed PMI, and 3% for normal cTnI.