Abstract
IntroductionCardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes.MethodsThis was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair.ResultsIn total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007).ConclusionsElevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.
Highlights
Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms
Elevated cardiac-specific troponin (cTnI) early after ruptured abdominal aortic aneurysms (rAAA) repair is an independent predictor for post-operative complications and death
Clinical characteristics of cTnI+ patients In total, 55% (n = 77) of patients had an elevated cTnI in the first 72 hours post-operatively, whereas 45% (n = 64) had no elevation in cTnI (Table 1). cTnI+ patients were more likely to have pre-existing coronary artery disease (CAD) (45.4% vs. 23.4%; odds ratios (OR) 2.72; 95% confidence intervals (CI), 1.31 to 5.62, P = 0.008), hypertension (77.9% vs. 60.9%; OR 2.26; 95% CI, 1.09 to 4.69, P = 0.04) and to be prescribed beta-blockers prior to hospital admission (36.3% vs. 17.2%; OR 2.75; 95% CI, 1.25 to 6.04, P = 0.01)
Summary
Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes. In a small retrospective study of 101 highrisk rAAA patients surviving to receive operative repair, 31% of early post-operative deaths were attributed to acute myocardial infarction (AMI) [2]. A small retrospective study found that coronary artery disease (CAD) was the most common late cause of death in survivors of rAAA repair [3]. These observations highlight that patients with rAAA have a high prevalence of CAD, which may be subclinical. These patients are susceptible to myocardial injury, which is associated with increased morbidity and mortality
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