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

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.