Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: results of the CARP trial

McFalls, Edward O.; Ward, Herbert B.; Möritz, Thomas; Apple, Fred S.; Goldman, Steven; Pierpont, Gordon L.; Larsen, G. C.; Hattler, Brack G.; Shunk, Kendrick A.; Littooy, Fred N.; Santilli, Steven M.; Rapp, Joseph H.; Thottapurathu, Lizy; Krupski, Witold; Reda, Domenic J.; Henderson, William G.

doi:10.1093/eurheartj/ehm620

Cited by 105 publications

(73 citation statements)

References 34 publications

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“…Additionally, patients whose revascularization was conducted using endovascular techniques did not suffer AMI, which may be because these methods reduce hemodynamic stress further still [20][21][22][23][24][25][26] .…”

Section: Discussionmentioning

confidence: 99%

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

et al. 2013

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Background: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. Objective: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. Material and Methods: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). Results: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. Conclusion: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

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Section: Discussionmentioning

confidence: 99%

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

et al. 2013

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“…Open abdominal aneurismal repair with crossclamp of the aorta and non-elective operations carry the highest risk of cardiovascular complications [18] in part due to the hemodynamic stress of the surgery, CAD burden, and the acuity of the condition that often hampers the ability to start preoperative interventions to mitigate cardiac risk.…”

Section: Cardiac Risk Stratification Prior To Vascular Surgerymentioning

confidence: 99%

Perioperative clinical variables and long-term survival following vascular surgery

García¹

2014

WJC

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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.

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“…Perioperative myocardial injury detectable by cardiac troponin elevation is estimated to occur in 5% to 25% of the over 200 million patients who undergo noncardiac surgery annually 1, 2, 3, 4. The association between postoperative troponin elevation and short‐term mortality is established 2, 3, 4, 5, 6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…The association between postoperative troponin elevation and short‐term mortality is established 2, 3, 4, 5, 6, 7, 8. However, how this hazard changes over time, and whether it persists long term are not well defined.…”

Section: Introductionmentioning

confidence: 99%

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

Reed

Horr

Young

et al. 2017

JAHA

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BackgroundThe time‐sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long‐term mortality differs by mechanism of myocardial injury are poorly understood.Methods and ResultsIn this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5‐years was stratified by cTnT level and mechanism of myocardial injury. During a median follow‐up of 26.9 months, there were 2149 (16.7%) deaths. By multivariable Cox proportional hazards analysis, there was a graded increase in mortality with any detectable cTnT compared to <0.01 ng/mL; cTnT 0.01 to 0.029 ng/mL hazard ratio (HR) 1.54 (95% CI 1.18–2.00, P=0.002), 0.03 to 0.099 ng/mL HR 1.86 (95% CI 1.49–2.31, P<0.001), 0.10 to 0.399 ng/mL HR 1.83 (95% CI 1.46–2.31, P<0.001), ≥0.40 ng/mL HR 2.62 (95% CI 2.06–3.32, P<0.001). Mortality for each mechanism of injury was greater than for patients with normal cTnT; baseline cTnT elevation HR 1.71 (95% CI 1.31–2.24; P<0.001), Type 2 myocardial infarction HR 1.88 (95% CI 1.57–2.24; P<0.001), Type 1 MI HR 2.56 (95% CI 2.56, 1.82–3.60; P<0.001). On Kaplan–Meier analysis, long‐term survival did not differ between mechanisms. The hazard of mortality was greatest within the first 10 months postsurgery. Consistent results were obtained in confirmatory propensity‐score matched analyses.ConclusionsAny detectable cTnT ≥0.01 ng/mL is associated with increased long‐term mortality after vascular surgery. This risk is greatest within the first 10 months postoperatively. While short‐term mortality is greatest with Type 1 myocardial infarction, long‐term mortality appears independent of the mechanism of injury.

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Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: results of the CARP trial

Cited by 105 publications

References 34 publications

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

Perioperative clinical variables and long-term survival following vascular surgery

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

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