Perioperative Myocardial Injury after Elective Open Abdominal Aortic Aneurysm Repair Predicts Outcome

Objective Myocardial injury, detected by rises in cardiac troponin I (TnI), is common and associated with decreased survival following open AAA surgery. We examined the relationship between perioperative myocardial injury and postoperative outcome. Design Observational Cohort Study. Methods Forty-th...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2008-04, Vol.35 (4), p.413-419
Main Authors: Ali, Z.A, Callaghan, C.J, Ali, A.A, Sheikh, A.Y, Akhtar, A, Pavlovic, A, Reza Nouraei, S.A, Dutka, D.P, Gaunt, M.E
Format: Article
Language:English
Subjects:
Abdominal aortic aneurysm
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - blood
Aortic Aneurysm, Abdominal - complications
Aortic Aneurysm, Abdominal - surgery
Disease-Free Survival
Female
Follow-Up Studies
Heart Failure - blood
Heart Failure - etiology
Heart Injuries - blood
Heart Injuries - etiology
Humans
Intraoperative Complications
Male
Myocardial Infarction - blood
Myocardial Infarction - etiology
Myocardial injury
Outcome
Postoperative Complications
Predictive Value of Tests
Surgery
Time Factors
Treatment Outcome
Troponin I - blood
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Summary:Objective Myocardial injury, detected by rises in cardiac troponin I (TnI), is common and associated with decreased survival following open AAA surgery. We examined the relationship between perioperative myocardial injury and postoperative outcome. Design Observational Cohort Study. Methods Forty-three consecutive patients who underwent elective open AAA repair were screened for perioperative myocardial injury or infarction using serial TnI measurements (taken on days 1, 3, and 7), ECG and clinical assessment. The primary outcome was survival free of cardiac failure, or myocardial infarction (MI) at follow-up. Results Twenty (47%) of the 43 patients had a TnI elevation. Of these, 11 (26%) patients met the criteria for MI. At a mean (±SD) follow-up of 1.5 ± 0.8 years, 12 (28%) subjects had experienced at least one endpoint event. Survival free of cardiac failure or MI was 55% in patients who had TnI rises compared to 87% in those without ( P = 0.02). Logistic regression revealed that TnI elevation was an independent predictor of outcome with an odds ratio of 5.4 (95% CI 1.2–2.4, P = 0.03). Conclusion Perioperative myocardial injury after elective open AAA repair predicts outcome after surgery. Routine TnI measurement should be considered in all patients, especially in those with high cardiovascular risk.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2007.10.007