CLINICAL RESEARCH
Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery
Giora Landesberg, MD, DSc* ,*,
Vadim Shatz, MD*,
Inna Akopnik, MD ,
Yehuda G. Wolf, MD,
Michael Mayer, DSc ,
Yacov Berlatzky, MD,
Charles Weissman, MD* and
Morris Mosseri, MD||
* Department of Anesthesiology, Jerusalem, Israel
Department of Critical Care Medicine, Jerusalem, Israel
Vascular Surgery, Jerusalem, Israel
Clinical Biochemistry, Jerusalem, Israel
|| Cardiology at Hadassah Medical Center, Jerusalem, Israel
Manuscript received April 15, 2003;
revised manuscript received May 13, 2003,
accepted May 20, 2003.
* Reprint requests and correspondence: Dr. Giora Landesberg, Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Jerusalem, Israel 91120.
gio{at}cc.huji.ac.il
OBJECTIVES: The aim of this study was to determine the long-term prognosis with postoperative markers of myocardial ischemia and infarction.
BACKGROUND: Cardiac troponins (cTn) are superior to creatine kinase-MB fraction (CK-MB) in detecting perioperative myocardial infarction (PMI). However, their threshold levels signifying PMI and their long-term prognostic value are not yet determined.
METHODS: A cohort of 447 consecutive patients who underwent 501 major vascular procedures was prospectively studied. Perioperative continuous 12-lead electrocardiogram monitoring, cardiac troponin-I (cTn-I) and/or cardiac troponin-T (cTn-T), and CK-MB levels on the first three postoperative days, and long-term survival were determined. The association of different cutoff levels of CK-MB, troponin, and ischemia duration with long-term survival was investigated.
RESULTS: Between 14 (2.9%) and 107 (23.9%) of the patients sustained PMI, depending on the biochemical criteria used. Elevated postoperative CK-MB, cTn, and prolonged (>30 min) ischemia, at all cutoff levels examined, predicted long-term mortality independent of the preoperative predictors: patient's age, type of vascular surgery, previous myocardial infarction, and renal failure (Cox multivariate analysis). Both CK-MB >10% and cTn-I >1.5 ng/ml and/or cTn-T >0.1 ng/ml independently predicted a 3.75-fold and 2.06-fold increase in long-term mortality (p = 0.006 and 0.012, respectively). Similarly, both CK-MB >5% and cTn-I >0.6 ng/ml and/or cTn-T >0.03 ng/ml independently predicted a 2.15-fold and 1.89-fold increase in mortality (p = 0.018 and 0.01, respectively). Patients with both these markers elevated had a 4.19-fold increase in mortality (p < 0.001).
CONCLUSIONS: Postoperative CK-MB and troponin, even at low cutoff levels, are independent and complementary predictors of long-term mortality after major vascular surgery.
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Abbreviations and Acronyms
| | ACS | = acute coronary syndrome(s) | | CAD | = coronary artery disease | | CK-MB | = creatine kinase-MB fraction | | cTn | = cardiac troponin | | ECG | = electrocardiogram/electrocardiograph/ electrocardiographic | | MI | = myocardial infarction | | PMI | = perioperative myocardial infarction |
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