Peak postoperative troponin levels outperform preoperative cardiac risk indices as predictors of long-term mortality after vascular surgery. Troponins and postoperative outcomes

Nicholas Marston, Jorge Brenes, Santiago Garcia, Michael Kuskowski, Selcuk Adabag, Steven Santilli, Edward O. McFalls

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: The utility of postoperative troponins as an independent predictor of long-term mortality after vascular surgery is unknown. Methods: One hundred sixty-four consecutive patients underwent vascular surgery and postoperative mortality was determined at 2.5 years. Troponins were drawn within 48 hours postsurgery and the peak levels, defined by the upper reference limit (URL), were categorized as negative (<URL), low positive (≥URL but <3 times the URL), or high positive (≥ 3 times the URL). A logistic regression model comprised all univariate predictors of long-term mortality and included peak troponin levels and the number of the preoperative revised cardiac risks. Results: Mortality in the high positive (n = 44), low positive (n = 41), and negative (n = 79) troponin groups was 46%, 17%, and 6%, respectively (P < .05). Independent predictors of long-term mortality were peak postoperative troponins (odds ratio [OR], 8.85; 95% confidence interval [CI], 3.29-23.81; P < .001), tissue loss (OR, 2.87; 95% CI, 1.03-8.00; P = .043), and use of statins (OR, 0.19; 95% CI, 0.07-0.49; P < .001). The c index for peak troponin levels was 0.75 (95% CI, 0.68-0.82; P < .01) and outperformed the Revised Cardiac Risk Index for predicting long-term outcomes. Conclusions: Among patients undergoing vascular surgery, an elevated postoperative troponin level provides incremental value in predicting long-term outcomes, when compared with standard preoperative cardiac and surgical risks.

Original languageEnglish (US)
Pages (from-to)66-72
Number of pages7
JournalJournal of Critical Care
Volume27
Issue number1
DOIs
StatePublished - Feb 1 2012

Keywords

  • Biomarkers
  • Cardiac risks
  • Outcomes
  • Statins
  • Tissue loss
  • Troponins
  • Vascular surgery

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