Abstract 14566: Mild Elevation in Cardiac Troponin T is Independently Associated With Long-Term Mortality After Intermediate or High-Risk Vascular Surgery

Abstract

Introduction: Myocardial injury is a risk factor for adverse outcomes after non-cardiac surgery. However, the prevalence of cardiac troponin T (cTnT) sampling after vascular surgery in real-word practice has not been well studied. Further, whether mild perioperative cTnT elevation is associated with long-term mortality is not established. Methods: This was a retrospective study of 13,196 patients who underwent intermediate or high-risk vascular surgery at a single center from January 1, 2010 - May 1, 2015. Patients were assessed for cTnT sampling within 96 hours of surgery. Cumulative 3 year mortality was stratified by absence of cTnT sampling, a normal value of 0.10 ng/mL. Cox proportional hazards analysis was used to adjust mortality for Revised Cardiac Risk Index (RCRI) score and other patient characteristics. Results: Mean age was 66.2±14.4 years, and 5,357 (40.6%) were female. Troponin was sampled in 3,296 (25.0%) patients, and among those 747 (5.7%) were elevated (positive yield 22.7%). There were 1,858 (14.1%) deaths. On Kaplan-Meier analysis, all-cause mortality was greatest with elevated cTnT (p<0.0001, Figure - A) and was higher across degrees of cTnT elevation (p<0.0001, Figure - B). After adjusting for RCRI score, age, gender, and diabetes, degree of cTnT elevation remained independently associated with mortality (Table). Conclusions: The degree of cTnT elevation independently predicts long-term mortality after vascular surgery. Even mild elevations of cTnT above threshold are associated with heightened risk of mortality, which extends well beyond the acute post-operative period.