Cardiac troponin I predicts short-term mortality in vascular surgery patients

被引:225
作者
Kim, LJ
Martinez, EA
Faraday, N
Dorman, T
Fleisher, LA
Perler, BA
Williams, GM
Chan, D
Pronovost, PJ
机构
[1] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Sch Med, Baltimore, MD 21287 USA
[2] Johns Hopkins Univ, Dept Med, Sch Med, Baltimore, MD 21287 USA
[3] Johns Hopkins Univ, Dept Surg, Sch Med, Baltimore, MD 21287 USA
[4] Johns Hopkins Univ, Dept Pathol, Sch Med, Baltimore, MD 21287 USA
[5] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA
[6] Johns Hopkins Univ Hosp, Dept Nursing, Baltimore, MD 21287 USA
关键词
cardiovascular diseases; complications; surgery;
D O I
10.1161/01.CIR.0000036016.52396.BB
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury that predicts outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who have undergone vascular surgery. However, postoperative surveillance with cardiac enzymes is not routinely performed in these patients. We evaluated the association between postoperative cTnI levels and 6-month mortality and perioperative myocardial infarction (MI) after vascular surgery. Methods and Results-Two hundred twenty-nine patients having aortic or infrainguinal vascular surgery or lower extremity amputation were included in this study. Blood samples were analyzed for cTnI immediately after surgery and the mornings of postoperative days 1, 2, and 3. An elevated cTnI was defined as serum concentrations > 1.5 ng/mL in any of the 4 samples. Twenty-eight patients (12%) had postoperative cTnI > 1.5ng/mL, which was associated with a 6-fold increased risk of 6-month mortality (adjusted OR, 5.9; 95% CI, 1.6 to 22.4) and a 27-fold increased risk of MI (OR, 27.1; 95% CI, 5.2 to 142.7). Furthermore, we observed a dose-response relation between cTnI concentration and mortality. Patients with cTnI >3.0 ng/mL had a significantly greater risk of death compared with patients with levels less than or equal to0.35 ng/mL (OR, 4.9; 95% CI, 1.3 to 19.0). Conclusions-Routine postoperative surveillance for cTnI is useful for identifying patients who have undergone vascular surgery who have an increased risk for short-term mortality and perioperative MI. Further research is needed to determine whether intervention in these patients can improve outcome.
引用
收藏
页码:2366 / 2371
页数:6
相关论文
共 32 条
[11]   CARDIAC ASSESSMENT FOR PATIENTS UNDERGOING NONCARDIAC SURGERY - A MULTIFACTORIAL CLINICAL RISK INDEX [J].
DETSKY, AS ;
ABRAMS, HB ;
FORBATH, N ;
SCOTT, JG ;
HILLIARD, JR .
ARCHIVES OF INTERNAL MEDICINE, 1986, 146 (11) :2131-2134
[12]  
Eagle KA, 1996, CIRCULATION, V93, P1278
[13]   Prognostic influence of elevated values of cardiac troponin I in patients with unstable angina [J].
Galvani, M ;
Ottani, F ;
Ferrini, D ;
Ladenson, JH ;
Destro, A ;
Baccos, D ;
Rusticali, F ;
Jaffe, AS .
CIRCULATION, 1997, 95 (08) :2053-2059
[14]   MULTIFACTORIAL INDEX OF CARDIAC RISK IN NON-CARDIAC SURGICAL PROCEDURES [J].
GOLDMAN, L ;
CALDERA, DL ;
NUSSBAUM, SR ;
SOUTHWICK, FS ;
KROGSTAD, D ;
MURRAY, B ;
BURKE, DS ;
OMALLEY, TA ;
GOROLL, AH ;
CAPLAN, CH ;
NOLAN, J ;
CARABELLO, B ;
SLATER, EE .
NEW ENGLAND JOURNAL OF MEDICINE, 1977, 297 (16) :845-850
[15]   Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I [J].
Hamm, CW ;
Goldmann, BU ;
Heeschen, C ;
Kreymann, G ;
Berger, J ;
Meinertz, T .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (23) :1648-1653
[16]   CORONARY-ARTERY DISEASE IN PERIPHERAL VASCULAR PATIENTS - A CLASSIFICATION OF 1000 CORONARY ANGIOGRAMS AND RESULTS OF SURGICAL-MANAGEMENT [J].
HERTZER, NR ;
BEVEN, EG ;
YOUNG, JR ;
OHARA, PJ ;
RUSCHHAUPT, WF ;
GRAOR, RA ;
DEWOLFE, VG ;
MALJOVEC, LC .
ANNALS OF SURGERY, 1984, 199 (02) :223-233
[17]  
HERTZER NR, 1989, ANESTHESIA HEART PAT
[18]   Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery [J].
Lee, TH ;
Marcantonio, ER ;
Mangione, CM ;
Thomas, EJ ;
Polanczyk, CA ;
Cook, EF ;
Sugarbaker, DJ ;
Donaldson, MC ;
Poss, R ;
Ho, KKL ;
Ludwig, LE ;
Pedan, A ;
Goldman, L .
CIRCULATION, 1999, 100 (10) :1043-1049
[19]  
LONDON MJ, 1988, ADV ANESTHESIA, P53
[20]   Applicability of cardiac troponin T and I for early risk stratification in unstable coronary artery disease [J].
Luscher, MS ;
Thygesen, K ;
Ravkilde, J ;
Heickendorff, L .
CIRCULATION, 1997, 96 (08) :2578-2585