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

85 Citations (Scopus)

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
StatePublished - Feb 2008
Externally publishedYes

Fingerprint

Blood Vessels
Coronary Artery Disease
Coronary Vessels
Myocardial Infarction
Troponin I
Troponin
Regression Analysis
Mortality
Logistic Models
Survival
Incidence

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: European Heart Journal, Vol. 29, No. 3, 02.2008, p. 394-401.

Research output: Contribution to journalArticle

McFalls, EO, Ward, HB, Moritz, TE, Apple, FS, Goldman, S, Pierpont, G, Larsen, GC, Hattler, B, Shunk, K, Littooy, F, Santilli, S, Rapp, J, Thottapurathu, L, Krupski, W, Reda, DJ & Henderson, WG 2008, 'Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: Results of the CARP trial', European Heart Journal, vol. 29, no. 3, pp. 394-401. https://doi.org/10.1093/eurheartj/ehm620
McFalls, Edward O. ; Ward, Herbert B. ; Moritz, Thomas E. ; Apple, Fred S. ; Goldman, Steven ; Pierpont, Gordon ; Larsen, Greg C. ; Hattler, Brack ; Shunk, Kendrick ; Littooy, Fred ; Santilli, Steve ; Rapp, Joseph ; Thottapurathu, Lizy ; Krupski, William ; Reda, Domenic J. ; Henderson, William G. / Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease : Results of the CARP trial. In: European Heart Journal. 2008 ; Vol. 29, No. 3. pp. 394-401.
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T2 - Results of the CARP trial

AU - McFalls, Edward O.

AU - Ward, Herbert B.

AU - Moritz, Thomas E.

AU - Apple, Fred S.

AU - Goldman, Steven

AU - Pierpont, Gordon

AU - Larsen, Greg C.

AU - Hattler, Brack

AU - Shunk, Kendrick

AU - Littooy, Fred

AU - Santilli, Steve

AU - Rapp, Joseph

AU - Thottapurathu, Lizy

AU - Krupski, William

AU - Reda, Domenic J.

AU - Henderson, William G.

PY - 2008/2

Y1 - 2008/2

N2 - 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.

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KW - Cardiac risks

KW - Coronary artery revascularization

KW - Myocardial infarction

KW - Outcomes

KW - Troponins

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