PC140. Routine Postoperative Troponin Testing Following Major Vascular Surgical Procedures Carries Short-Term and Long-Term Prognostic Significance

Abstract

This study determined the utility of routine postoperative troponin T (PO TnT) measurements in patients undergoing major vascular surgical reconstructions (VSRs). Data from consecutive patients undergoing VSRs and routine PO TnT measurement from 2010 to 2012 were retrospectively analyzed. An elevated Tn was >0.01 ng/mL within the current admission, further characterized as low (0.02-0.2 ng/mL) and high (>0.2 ng/mL). Patients without complete Tn panels or research authorization were excluded. Cox proportional hazards model was used to evaluate the effect of preoperative risk factors, type of procedure and PO TnT levels on early-term and long-term mortality. Of 1814 patients undergoing VSRs over the 3-year period, 1632 (1136 males, 496 females; mean age 70 years) met inclusion criteria. There were 1088 open, 529 endovascular, and 15 hybrid procedures. TnT levels were >0.01 ng/mL in 394 patients (24%). Of these, 56 were attributed to non-ST segment elevation myocardial infarction, 6 ST segment elevation myocardial infarction, 46 demand ischemia, 22 miscellaneous cardiac abnormalities, 96 renal insufficiency, and 168 had asymptomatic troponin leaks. Medical management was optimized in all patients. Coronary catheterizations were performed in 13 patients and intervention in seven. Thirty-day mortality was significantly higher in Tn+ vs Tn– patients (2.9% vs 0.7%, P < .001). On multivariate analysis, elevated Tn (hazard ratio [HR], 2.7; P < .001), Society for Vascular Surgery/American Association for Vascular Surgery Score (HR, 1.08 per 1 point; P < .01) and age (HR, 1.20 per 10 years; P < .05) were associated with mortality. Cumulative probability of death in Tn+ patients remained significantly higher at 1 (13% vs 3%), 2 (17% vs 4%), and 4 years (31% vs 10%; P < .001) and was directly proportional to the maximum Tn level (P < .001, Fig). Comparison of the 168 patients with asymptomatic Tn leaks to Tn– patients yielded similar results, with significantly higher mortality at 30 days (2.5% vs 0.7%), 1 (7% vs 3%), 2 (12% vs 4%), and 4 years (25% vs 10%; P < .001). Elevated TnT levels, including mild asymptomatic elevations, following major VSRs are independently associated with higher early-term and long-term mortality. Routine Tn testing is worthwhile and serves to risk-stratify patients for future medical and surgical care.