Post-operative troponin I elevation was independently associated with an increased long-term risk of death or acute myocardial infarction (adjusted HR 4.73; 95% CI 2.92-7.65; P<0.0001).
Cohort (n=391)
Does pre-operative ACC/AHA risk stratification and post-operative troponin I elevation predict death or myocardial infarction in patients undergoing elective major vascular surgery?
Post-operative troponin I elevation and pre-operative ACC/AHA clinical risk predictors strongly and independently predict early and long-term death or MI in patients undergoing elective major vascular surgery.
Hazard Ratio: 4.73 (95% CI 2.92–7.65)
p-value: p=<0.0001
AIMS: The objectives of this study are to evaluate the prognostic role of pre-operative stratification in patients undergoing elective major vascular surgery, the timing of adverse outcomes, and the predictive role of troponin (cTn). METHODS AND RESULTS: Consecutive vascular surgery candidates (n=391) were prospectively stratified and treated according to the ACC/AHA guidelines. The patients were categorized into three groups: (1) with coronary revascularization in the past 5 years, (2) with intermediate clinical risk predictors, and (3) with minor or no clinical risk predictors. cTnI was measured post-operatively. By 18 months, 18.7% of subjects had experienced death or acute myocardial infarction (MI) (by the ACC/ESC criteria). The hazard ratio (HR) was 5.21 (95% CI=2.60-10.43; P<0.0001) in group 1 and 2.58 (95% CI=1.27-4.38; P=0.004) in group 2 when compared with group 3. Most events occurred within 30 days. Elevations of cTnI were associated with adverse outcomes even after multivariable adjustment at long-term (adjusted overall HR=4.73, 95% CI=2.92-7.65; P<0.0001) and at 30 days (adjusted HR=5.52, 95% CI=3.23-9.42; P<0.0001). CONCLUSION: After pre-operative stratification, patients undergoing elective major vascular surgery remain at high risk of MI and death. Events occur mainly early after surgery. cTnI elevations are frequent and independently associated with increased risk. These findings suggest the need for a major re-evaluation of our approach to these patients.
Bursi et al. (Fri,) conducted a cohort in elective major vascular surgery (n=391). Post-operative troponin I (cTnI) elevation vs. No cTnI elevation was evaluated on death or acute myocardial infarction (MI) (HR 4.73, 95% CI 2.92-7.65, p=<0.0001). Post-operative troponin I elevation was independently associated with an increased long-term risk of death or acute myocardial infarction (adjusted HR 4.73; 95% CI 2.92-7.65; P<0.0001).