The Effect of Postoperative Myocardial Ischemia on Long-Term Survival After Vascular Surgery

Abstract

The impact of postoperative troponin elevation on long-term survival after vascular surgery is not well defined. We hypothesize that a troponin elevation is associated with reduced long-term survival. The VSGNE identified all patients who underwent carotid revascularization, open AAA repair, endovascular AAA repair, or infrainguinal lower extremity bypass (2003-2011). The effect of postoperative troponin elevation and myocardial infarction (MI) on 5 year survival was evaluated using Kaplan Meier analysis and Cox Proportional Hazards models. In 16,363 patients, the incidence of postoperative troponin elevation and MI were 1.3% (n = 211) and 1.6%(n = 264), respectively. Both were associated with reduced 5 year survival: no ischemia, 73%; troponin elevation, 54%; MI, 33% (P < .0001). This pattern was observed for each procedure subgroup analysis (P < .0001). Troponin elevation (HR, 1.45; 95% CI, 1.1-2.0; P = .02) and MI (HR, 2.9; 95% CI, 2.3-3.8; P < .0001) were independent predictors of reduced 5 year survival. Postoperative troponin elevation and MI predict 26% and 55% lower 5 year survival, respectively, after vascular procedures compared with no myocardial ischemia. This highlights the need to better characterize factors leading to postoperative myocardial ischemia. Postoperative troponin elevation alone is a marker for high-risk patients who might benefit from more aggressive cardiac optimization.