Peak postoperative troponin levels outperform preoperative cardiac risk indices as predictors of long-term mortality after vascular surgery

Marston, Nicholas; Brenes, Jorge; García, Santiago; Kuskowski, Michael A.; Adabag, Selçuk; Santilli, Steven M.; McFalls, Edward O.

doi:10.1016/j.jcrc.2011.06.004

Cited by 32 publications

(27 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another trial of 100 patients randomly assigned to 20 mg of atorvastatin or placebo prior to vascular surgery, the use of statins was associated with a significant reduction in cardiac events, from 26% to 8% at 6 mo [39] . An observational study of 164 veterans undergoing vascular surgery at our medical center demonstrated that utilization of statin drugs was associated with a reduction in long-term mortality [5] . Guidelines recommend the use of statins in patients with peripheral arterial disease to reduce cardiovascular events [2] .…”

Section: Management Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

“…Vascular surgery is considered a high-risk operation with one in four patients experiencing a peri-operative myocardial infarction (PMI), which is associated with increased long-term mortality [5,6] . Identifying the clinical variables associated with increased risk of PMI prior to surgery as well as defining the best strategy for surveillance of PMI after high-risk surgery are of critical importance in clinical practice to mitigate risk and improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative clinical variables and long-term survival following vascular surgery

García¹

2014

WJC

Self Cite

View full text Add to dashboard Cite

Cardiovascular disease is the leading cause of death in patients with peripheral arterial disease (PAD). Coronary artery disease (CAD) is highly prevalent, and often times coexist, in patients with PAD. The management of patients with PAD that requires a high-risk vascular surgical procedure for intermittent claudication, critical limb ischemia or expanding abdominal aortic aneurysm requires risk stratification with the revised cardiac risk index, optimization of medical therapies, and limited use of cardiac imaging prior to surgery. Preventive revascularization in patients with stable CAD, with the sole intention to mitigate the risk of cardiac complications in the peri-operative period, is not effective and may be associated with significant bleeding and thrombotic risks, in particular if stents are used. A strategy of universal use of cardiac troponins in the perioperative period for active surveillance of myocardial ischemia may be more reasonable and cost-effective than the current standard of care of widespread use of cardiac imaging prior to high-risk surgery. An elevated cardiac troponin after vascular surgery is predictive of longterm mortality risk. Medical therapies such as aspirin and statins are recommended for patients with postoperative myocardial ischemia. Ongoing trials are assessing the role of novel anticoagulants. Additional research is needed to define the role of cardiac imaging and invasive angiography in this population.

show abstract

Section: Management Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative clinical variables and long-term survival following vascular surgery

García¹

2014

WJC

Self Cite

View full text Add to dashboard Cite

show abstract

“…4 This study is but the latest in a series of investigations that have concluded that postoperative measurement of cardiac troponin is a better predictor of cardiac outcomes than preoperative-risk algorithms. [4][5][6][7][8] Intuitively, this link is not surprising. Surgery represents the ultimate physiologic stress test.…”

mentioning

confidence: 94%

Rethinking cardiac risk reduction after noncardiac surgery: The postoperative Carpe diem

Chopra

Eagle

2012

Journal of Hospital Medicine

View full text Add to dashboard Cite

Patients undergoing noncardiac surgery frequently experience major adverse cardiac events. As a significant proportion of these patients develop cardiac complications despite optimal use of preoperative clinical risk‐prediction algorithms, physicians have long searched for better methods of forecasting and ameliorating cardiac risk in this population. Recently, postoperative troponin levels have been found to be powerful and independent predictors of cardiovascular mortality in patients undergoing noncardiac surgery. Importantly, the predictive properties of these markers outperform preoperative clinical risk‐prediction algorithms. We thus posit that the assessment of postoperative troponin represents an as yet untapped “golden opportunity” for cardiac risk reduction. As cardiac troponin isolates an unusually high‐risk subgroup, we outline a strategy that utilizes this marker to improve cardiac outcomes. Where pertinent, strengths and limitations of this approach are discussed and areas of uncertainty identified. As with all hypotheses, this proposition fuels many questions and calls for a research agenda dedicated to quantifying risk or benefit, and defining best practices. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

show abstract

“…Postoperative troponin levels more than three times the URL outperformed clinical risk prediction variables. 7 When the absolute change in highly sensitive cardiac troponin T (hsTnT) within the first 24 postoperative hours of vascular surgery was added to the Revised Cardiac Risk Index (RCRI), the predictive accuracy of the score was significantly improved. 8 The incidence of PMI or MINS and its impact on hospital mortality in the postoperative vascular surgical patient requiring intensive care in a South African context has not been described.…”

Section: Introductionmentioning

confidence: 99%

Incidence and hospital mortality of vascular surgery patients with perioperative myocardial infarction (PMI) or myocardial injury after non-cardiac surgery (MINS)

Kisten

Biccard

2017

Southern African Journal of Anaesthesia and Analgesia

View full text Add to dashboard Cite

Peak postoperative troponin levels outperform preoperative cardiac risk indices as predictors of long-term mortality after vascular surgery

Cited by 32 publications

References 22 publications

Perioperative clinical variables and long-term survival following vascular surgery

Perioperative clinical variables and long-term survival following vascular surgery

Rethinking cardiac risk reduction after noncardiac surgery: The postoperative Carpe diem

Incidence and hospital mortality of vascular surgery patients with perioperative myocardial infarction (PMI) or myocardial injury after non-cardiac surgery (MINS)

Contact Info

Product

Resources

About