Cardiac troponin after major vascular surgery: The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization

Giora Landesberg, Morris Mosseri, Vadim Shatz, Inna Akopnik, Moshe Bocher, Michael Mayer, Haim Anner, Yacov Berlatzky, Charles Weissman

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.

Original languageEnglish
Pages (from-to)569-575
Number of pages7
JournalJournal of the American College of Cardiology
Volume44
Issue number3
DOIs
StatePublished - Aug 4 2004
Externally publishedYes

Fingerprint

Troponin
Thallium
Blood Vessels
Ischemia
Troponin T
Troponin I
Odds Ratio
MB Form Creatine Kinase
Multivariate Analysis
Logistic Models
Mortality
Incidence

Keywords

  • CABG
  • CAD
  • cardiac troponin
  • CK-MB
  • coronary artery bypass graft surgery
  • coronary artery disease
  • creatine kinase-MB fraction
  • cTn
  • MI
  • myocardial infarction
  • odds ratio
  • OR
  • PCI
  • percutaneous coronary intervention
  • preoperative thallium scanning
  • PTS

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Cardiac troponin after major vascular surgery : The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. / Landesberg, Giora; Mosseri, Morris; Shatz, Vadim; Akopnik, Inna; Bocher, Moshe; Mayer, Michael; Anner, Haim; Berlatzky, Yacov; Weissman, Charles.

In: Journal of the American College of Cardiology, Vol. 44, No. 3, 04.08.2004, p. 569-575.

Research output: Contribution to journalArticle

Landesberg, Giora ; Mosseri, Morris ; Shatz, Vadim ; Akopnik, Inna ; Bocher, Moshe ; Mayer, Michael ; Anner, Haim ; Berlatzky, Yacov ; Weissman, Charles. / Cardiac troponin after major vascular surgery : The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. In: Journal of the American College of Cardiology. 2004 ; Vol. 44, No. 3. pp. 569-575.
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abstract = "Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0{\%} incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4{\%} conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4{\%} and 6.4{\%} low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.",
keywords = "CABG, CAD, cardiac troponin, CK-MB, coronary artery bypass graft surgery, coronary artery disease, creatine kinase-MB fraction, cTn, MI, myocardial infarction, odds ratio, OR, PCI, percutaneous coronary intervention, preoperative thallium scanning, PTS",
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T2 - The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization

AU - Landesberg, Giora

AU - Mosseri, Morris

AU - Shatz, Vadim

AU - Akopnik, Inna

AU - Bocher, Moshe

AU - Mayer, Michael

AU - Anner, Haim

AU - Berlatzky, Yacov

AU - Weissman, Charles

PY - 2004/8/4

Y1 - 2004/8/4

N2 - Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.

AB - Objectives We sought to determine the role of preoperative predictors, particularly ischemia, on preoperative thallium scanning (PTS) and coronary revascularization on low-level and conventional troponin elevations after major vascular surgery. Background Postoperative cardiac troponin (cTn) elevations have recently been shown to predict both short- and long-term mortality after vascular surgery. Methods The perioperative data, including PTS and subsequent coronary revascularization, continuous perioperative 12-lead ST-segment trend monitoring, cTn-I and/or cTn-T, and creatine kinase-MB fraction in the first three postoperative days, were prospectively collected in 501 consecutive elective major vascular procedures. Results Moderate to severe inducible ischemia on PTS was associated with a 49.0% incidence of low-level (cTn-I >0.6 and/or cTn-T >0.03 ng/ml) and 22.4% conventional (cTn-I >1.5 and/or cTn-T >0.1 ng/ml) troponin elevation. In contrast, patients with preoperative coronary revascularization had 23.4% and 6.4% low-level and conventional troponin elevations, respectively, similar to patients without ischemia on PTS. By multivariate logistic regression, ischemia on PTS was the most important predictor of both low-level and conventional troponin elevations (adjusted odds ratios [ORs] 2.5 and 2.7, p = 0.02 and 0.04, respectively), whereas preoperative coronary revascularization predicted less troponin elevations (adjusted ORs 0.35 and 0.16, p = 0.045 and 0.022, respectively). Postoperative ischemia (>10 min), the more so prolonged (>30 min) ischemia was the only independent predictor of troponin elevation if added with the preoperative predictors to the multivariate analysis (ORs 15.8 and 22.8, respectively; p < 0.001). Conclusions Troponin elevations occur frequently after vascular surgery. They are strongly associated with postoperative ischemia, predicted by inducible ischemia on PTS, and reduced by preoperative coronary revascularization.

KW - CABG

KW - CAD

KW - cardiac troponin

KW - CK-MB

KW - coronary artery bypass graft surgery

KW - coronary artery disease

KW - creatine kinase-MB fraction

KW - cTn

KW - MI

KW - myocardial infarction

KW - odds ratio

KW - OR

KW - PCI

KW - percutaneous coronary intervention

KW - preoperative thallium scanning

KW - PTS

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