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

Edward O. McFalls, Herbert B. Ward, Thomas E. Moritz, Fred S. Apple, Steven Goldman, Gordon Pierpont, Greg C. Larsen, Brack Hattler, Kendrick Shunk, Fred Littooy, Steve Santilli, Joseph Rapp, Lizy Thottapurathu, William Krupski, Domenic J. Reda, William G. Henderson

Research output: Contribution to journalArticle

87 Scopus citations

Abstract

Aims: The predictors and outcomes of patients with a peri-operative elevation in cardiac troponin I above the 99th percentile of normal following an elective vascular operation have not been studied in a homogeneous cohort with documented coronary artery disease. Methods and results: The Coronary Artery Revascularization Prophylaxis (CARP) trial was a randomized trial that tested the benefit of coronary artery revascularization prior to vascular surgery. Among 377 randomized patients, core lab samples for peak cardiac troponin I concentrations were monitored following the vascular operation and the blinded results were correlated with outcomes. A peri-operative myocardial infarction (MI), defined by an increase in cardiac troponin I greater than the 99th percentile reference (≥0.1 μg/L), occurred in 100 patients (26.5%) and the incidence was not dissimilar in patients with and without pre-operative coronary revascularization (24.2 vs. 28.6%; P = 0.32). By logistic regression analysis, predictors of MI (odds risk; 95%CI; P-value) were age >70 (1.84; 1.14-2.98; P = 0.01), abdominal aortic surgery (1.82; 1.09-3.03; P = 0.02), diabetes (1.86; 1.11-3.11; P = 0.02), angina (1.67; 1.03-2.64; P = 0.04), and baseline STT abnormalities (1.62; 1.00-2.6; P = 0.05). At 2.5 years post-surgery, the probability of survival in patients with and without the MI was 0.73 and 0.84, respectively (P = 0.03, log-rank test). Using a Cox proportional hazards regression analysis, a peri-operative MI in diabetic patients was a strong predictor of long-term mortality (hazards ratio: 2.43; 95% CI: 1.31-4.48; P < 0.01). Conclusion: Among patients with coronary artery disease who undergo vascular surgery, a peri-operative elevation in cardiac troponin levels is common and in combination with diabetes, is a strong predictor of long-term mortality. These data support the utility of cardiac troponins as a means of stratifying high-risk patients following vascular operations.

Original languageEnglish (US)
Pages (from-to)394-401
Number of pages8
JournalEuropean Heart Journal
Volume29
Issue number3
DOIs
Publication statusPublished - Feb 2008
Externally publishedYes

    Fingerprint

Keywords

  • Cardiac risks
  • Coronary artery revascularization
  • Myocardial infarction
  • Outcomes
  • Troponins
  • Vascular surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this