JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2003; 42:1547-1554, doi:10.1016/j.jacc.2003.05.001
© 2003 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Landesberg, G.
Right arrow Articles by Mosseri, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Landesberg, G.
Right arrow Articles by Mosseri, M.

CLINICAL RESEARCH

Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery

Giora Landesberg, MD, DSc*{dagger},*, Vadim Shatz, MD*{dagger}, Inna Akopnik, MD{ddagger}, Yehuda G. Wolf, MD{ddagger}, Michael Mayer, DSc§, Yacov Berlatzky, MD{ddagger}, Charles Weissman, MD*{dagger} and Morris Mosseri, MD||

* Department of Anesthesiology, Jerusalem, Israel
{dagger} Department of Critical Care Medicine, Jerusalem, Israel
{ddagger} 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.

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




This article has been cited by other articles:


Home page
 Canadian J. AnesthesiaHome page
M.-C. Parent and S. Rinfret
The unresolved issues with risk stratification and management of patients with coronary artery disease undergoing major vascular surgery: [Questions non resolues concernant la stratification du risque et la prise en charge des patients atteints de maladie coronarienne subissant une chirurgie vasculaire majeure]
Can J Anesth, August 1, 2008; 55(8): 542 - 556.
[Abstract] [Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
B. HARTE and A. K. JAFFER
Perioperative beta-blockers in noncardiac surgery: Evolution of the evidence
Cleveland Clinic Journal of Medicine, July 1, 2008; 75(7): 513 - 519.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
G. Gregoratos
Current Guideline-Based Preoperative Evaluation Provides the Best Management of Patients Undergoing Noncardiac Surgery
Circulation, June 17, 2008; 117(24): 3134 - 3144.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
K. Thygesen, J. S. Alpert, A. S. Jaffe, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force
Reply.
J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1826 - 1827.
[Full Text] [PDF]

Home page
 Contin Educ Anaesth Crit Care PainHome page
J. A. Wolfe Barry, J. H. Barth, and S. J. Howell
Cardiac troponins: their use and relevance in anaesthesia and critical care medicine
CEACCP, April 1, 2008; 8(2): 62 - 66.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
G. Landesberg and M. Mosseri
PRO: Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery
Anesth. Analg., March 1, 2008; 106(3): 759 - 763.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
K. Thygesen, J. S. Alpert, A. S. Jaffe, H. D. White, and On behalf of the Joint ESC/ACCF/AHA/WHF Task Force
Intraoperative myocardial infarction in non-cardiac surgery: is a universal definition feasible? reply
Eur. Heart J., February 2, 2008; 29(4): 567 - 568.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
O. Schouten, J. J. Bax, and D. Poldermans
Preoperative cardiac risk assessment in vascular surgery patients: seeing beyond the perioperative period
Eur. Heart J., February 1, 2008; 29(3): 283 - 284.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. O. McFalls, H. B. Ward, T. E. Moritz, F. S. Apple, S. Goldman, G. Pierpont, G. C. Larsen, B. Hattler, K. Shunk, F. Littooy, et al.
Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: results of the CARP trial
Eur. Heart J., February 1, 2008; 29(3): 394 - 401.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
R. Wiessner, K. Hannemann-Pohl, R. Ziebig, H. Grubitzsch, B. Hocher, O. Vargas-Hein, A. Lun, I. Schimke, and L. Liefeldt
Impact of kidney function on plasma troponin concentrations after coronary artery bypass grafting
Nephrol. Dial. Transplant., January 1, 2008; 23(1): 231 - 238.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al.
National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure
Clin. Chem., December 1, 2007; 53(12): 2086 - 2096.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
S. Mantha, J. Foss, J. E. Ellis, and M. F. Roizen
Intense Cardiac Troponin Surveillance for Long-Term Benefits Is Cost-Effective in Patients Undergoing Open Abdominal Aortic Surgery: A Decision Analysis Model
Anesth. Analg., November 1, 2007; 105(5): 1346 - 1356.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242.
[Full Text] [PDF]

Home page
 CirculationHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Circulation, October 23, 2007; 116(17): e418 - e500.
[Full Text] [PDF]

Home page
 CirculationHome page
F. W. LoGerfo
Carotid Stents: Unleashed, Unproven
Circulation, October 2, 2007; 116(14): 1596 - 1601.
[Full Text] [PDF]

Home page
 CirculationHome page
Z. A. Ali, C. J. Callaghan, E. Lim, A. A. Ali, S.A. Reza Nouraei, A. M. Akthar, J. R. Boyle, K. Varty, R. K. Kharbanda, D. P. Dutka, et al.
Remote Ischemic Preconditioning Reduces Myocardial and Renal Injury After Elective Abdominal Aortic Aneurysm Repair: A Randomized Controlled Trial
Circulation, September 11, 2007; 116(11_suppl): I-98 - I-105.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
E. Y.W. Wong, H. P. Lawrence, and D. T. Wong
The effects of prophylactic coronary revascularization or medical management on patient outcomes after noncardiac surgery - a meta-analysis: [Les effets de la revascularisation coronarienne prophylactique ou de la prise en charge medicale sur le devenir des patients apres une chirurgie non-cardiaque : une meta-analyse]
Can J Anesth, September 1, 2007; 54(9): 705 - 717.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328.
[Abstract] [Full Text] [PDF]

Home page
 Vasc MedHome page
E. R. Mohler III, S. Mantha, A. B. Miller, D. Poldermans, A. B. Cropp, L. B. St. Aubin, C. B. Billing JR, and L. A. Fleisher
Should troponin and creatinine kinase be routinely measured after vascular surgery?
Vascular Medicine, August 1, 2007; 12(3): 175 - 181.
[Abstract] [PDF]

Home page
 Vasc MedHome page
T. S. Perlstein and J. A. Beckman
Peri-operative cardiac biomarker surveillance: a strategy in need of a goal
Vascular Medicine, August 1, 2007; 12(3): 211 - 213.
[PDF]

Home page
 Br J AnaesthHome page
S. J. Howell
Carotid endarterectomy
Br. J. Anaesth., July 1, 2007; 99(1): 119 - 131.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
Y. Le Manach, G. Godet, P. Coriat, C. Martinon, M. Bertrand, M.-H. Fleron, and B. Riou
The Impact of Postoperative Discontinuation or Continuation of Chronic Statin Therapy on Cardiac Outcome After Major Vascular Surgery
Anesth. Analg., June 1, 2007; 104(6): 1326 - 1333.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Raux, G. Godet, R. Isnard, P. Mergoni, J.-P. Goarin, M. Bertrand, M. Fleron, P. Coriat, and B. Riou
Low negative predictive value of dobutamine stress echocardiography before abdominal aortic surgery
Br. J. Anaesth., December 1, 2006; 97(6): 770 - 776.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. O. Adesanya, J. A. de Lemos, N. B. Greilich, and C. W. Whitten
Management of perioperative myocardial infarction in noncardiac surgical patients.
Chest, August 1, 2006; 130(2): 584 - 596.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
E. W. Moretti, M. F. Newman, L. H. Muhlbaier, D. Whellan, R. P. Petersen, D. Rossignol, C. B. McCants Jr, B. Phillips-Bute, and E. Bennett-Guerrero
Effects of Decreased Preoperative Endotoxin Core Antibody Levels on Long-term Mortality After Coronary Artery Bypass Graft Surgery
Arch Surg, July 1, 2006; 141(7): 637 - 641.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. N. Vicenzi, T. Meislitzer, B. Heitzinger, M. Halaj, L. A. Fleisher, and H. Metzler
Coronary artery stenting and non-cardiac surgery--a prospective outcome study
Br. J. Anaesth., June 1, 2006; 96(6): 686 - 693.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
L. F. Souza
Anesthesia research needs definitions.
Anesth. Analg., April 1, 2006; 102(4): 1287 - 1287.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
S. J. Howell, J. P. Thompson, A. F. Nimmo, C. Snowden, N. D. Edwards, J. Carlisle, M.-S. Suleiman, and A. Baumbach
Relationship between perioperative troponin elevation and other indicators of myocardial injury in vascular surgery patients
Br. J. Anaesth., March 1, 2006; 96(3): 303 - 309.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
C. R. Henry, D. Satran, B. Lindgren, C. Adkinson, C. I. Nicholson, and T. D. Henry
Myocardial Injury and Long-term Mortality Following Moderate to Severe Carbon Monoxide Poisoning
JAMA, January 25, 2006; 295(4): 398 - 402.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
L. Babuin and A. S. Jaffe
Troponin: the biomarker of choice for the detection of cardiac injury
Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
F. Bursi, L. Babuin, A. Barbieri, L. Politi, M. Zennaro, T. Grimaldi, A. Rumolo, M. Gargiulo, A. Stella, M. G. Modena, et al.
Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation
Eur. Heart J., November 2, 2005; 26(22): 2448 - 2456.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, J. Piotrowski, K. Mann, and H. Jakob
Prognostic Value of Preoperative Cardiac Troponin I in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery
Chest, November 1, 2005; 128(5): 3526 - 3536.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
P.J. Devereaux, L. Goldman, S. Yusuf, K. Gilbert, K. Leslie, and G. H. Guyatt
Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review
Can. Med. Assoc. J., September 27, 2005; 173(7): 779 - 788.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
H.-J. Priebe
Perioperative myocardial infarction--aetiology and prevention
Br. J. Anaesth., July 1, 2005; 95(1): 3 - 19.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
F. Bonnet and E. Marret
Influence of anaesthetic and analgesic techniques on outcome after surgery
Br. J. Anaesth., July 1, 2005; 95(1): 52 - 58.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
W. S. Beattie
Evidence-based perioperative risk reduction
Can J Anesth, June 1, 2005; 52(suppl_1): R5 - R5.
[Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Thielmann, P. Massoudy, M. Neuhauser, S. Knipp, M. Kamler, G. Marggraf, J. Piotrowski, and H. Jakob
Risk stratification with cardiac troponin I in patients undergoing elective coronary artery bypass surgery
Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 861 - 869.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y.W. Lew, J. Narula, D. Sahn, et al.
Highlights of the year in JACC 2004
J. Am. Coll. Cardiol., January 4, 2005; 45(1): 137 - 153.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. G. Monk, V. Saini, B. C. Weldon, and J. C. Sigl
Anesthetic Management and One-Year Mortality After Noncardiac Surgery
Anesth. Analg., January 1, 2005; 100(1): 4 - 10.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. Landesberg, M. Mosseri, V. Shatz, I. Akopnik, M. Bocher, M. Mayer, H. Anner, Y. Berlatzky, and C. Weissman
Cardiac troponin after major vascular surgery: The role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization
J. Am. Coll. Cardiol., August 4, 2004; 44(3): 569 - 575.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. Mukherjee and K. A. Eagle
Ischemia, revascularization, and perioperative troponin elevation after vascular surgery
J. Am. Coll. Cardiol., August 4, 2004; 44(3): 576 - 578.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
S. J. Howell and J. W. Sear
Perioperative myocardial injury: individual and population implications
Br. J. Anaesth., July 1, 2004; 93(1): 3 - 8.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
K A A Fox, J Birkhead, R Wilcox, C Knight, and J Barth
British Cardiac Society Working Group on the definition of myocardial infarction
Heart, June 1, 2004; 90(6): 603 - 609.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, D. Berman, G. K. Feld, B. H. Greenberg, J. D. Knoke, K. U. Knowlton, W. Y. W. Lew, and S. Tsimikas
Highlights of the year in JACC 2003
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2156 - 2166.
[Full Text] [PDF]


HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2003 by the American College of Cardiology Foundation.