Frequency of Increase in Cardiac Troponin Levels After Peripheral Arterial Operations (Carotid Endarterectomy, Abdominal Aorta Procedure, Distal Bypass) and Their Effect on Medical Management

Yader Sandoval, Marina Zakharova, Thomas S. Rector, Emmanouil S. Brilakis, Todd Drexel, Edward O. McFalls, Santiago Garcia

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant. Intensification of medical therapy was defined as initiation of aspirin or initiation or increases in the dose of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers, statins, or β blockers and was left to the discretion of treating physicians. From June 2011 to April 2015, a total of 185 patients (mean age 68 ± 7 years, 100% men) were enrolled in the trial. A total of 28 patients (15%) had significant increases in cTnI after vascular surgery, and 38 (20.5%) had their medical therapies intensified in the perioperative period. Among patients with increases in cTnI, 11 (39%) had intensification of medical therapy versus 27 patients (17%) with no or smaller increases in cTnI (p = 0.02). Among those patients with ΔcTnI ≥0.01 μg/l, hospital readmissions at 3 to 6 months were 7.6% for the intensification group versus 25% for the no intensification group (p = 0.18). Mortality rate at 6 months was low in both groups (2.6% vs 0%, respectively, p = 0.13). In conclusion, among patients undergoing vascular surgery, perioperative increases in cTn were associated with initiation or intensification of medical therapies for coronary artery disease at the time of discharge.

Original languageEnglish (US)
Pages (from-to)1929-1934
Number of pages6
JournalAmerican Journal of Cardiology
Volume118
Issue number12
DOIs
StatePublished - Dec 15 2016

Bibliographical note

Funding Information:
Dr. Sandoval has no financial relationships and is a non salaried advisor to Roche Clinical Diagnostics. Dr. Brilakis has received speaker honoraria from St Jude Medical, Terumo, and Bridgepoint Medical; spouse is an employee of Medtronic. Dr. Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development. Dr. Garcia is a consultant for Surmodics. All other authors have nothing to disclose.

Publisher Copyright:
© 2016

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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