Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endarterectomy

Grobben, Remco B.; Vrijenhoek, Joyce E. P.; Nathoe, Hendrik M.; Ruijter, Hester M. den; Waes, Judith A R van; Peelen, Linda M.; Klei, Wilton A. van; Borst, Gert J. de

doi:10.1016/j.ejvs.2015.09.023

Cited by 21 publications

(5 citation statements)

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“…The authors suggested that perioperative myocardial injury cannot overcome the surgical stress, and inability to cope with the stress may have turned out as high mortality 29 . Furthermore, clinically silent troponin elevation from myocardial injury during postoperative period is known to increase the long-term mortality after major non-cardiac surgery 30 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors of postoperative major adverse cardiac events after radical cystectomy: implication of diastolic dysfunction

Jun

Kim

et al. 2019

Sci Rep

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Radical cystectomy, which is a standard treatment of muscle invasive and high-grade non-invasive bladder tumour, is accompanied with high rates of postoperative complications including major adverse cardiac events (MACE). Diastolic dysfunction is associated with postoperative complications. We evaluated perioperative risk factors including diastolic dysfunction related with MACE within 6 months after radical cystectomy. The 546 patients who underwent elective radical cystectomy were included. Diastolic dysfunction was defined as early transmitral flow velocity (E)/early diastolic mitral annulus velocity (e′) > 15. Logistic regression analysis, Kaplan-Meier survival analysis and log-rank test were performed. MACE within 6 months after radical cystectomy developed in 43 (7.9%) patients. MACE was related with female (odds ratio 2.546, 95% confidence interval 1.166–5.557, P = 0.019) and diastolic dysfunction (odds ratio 3.077, 95% confidence interval 1.147–8.252, P = 0.026). The 6-month mortality were significantly higher in the MACE group, and hospital stay and intensive care unit stay were significantly longer in the MACE group compared to the non-MACE group. Accordingly, preoperative diastolic dysfunction (E/e′ > 15) was related with postoperative MACE and MACE was related with 6-month survival after radical cystectomy. These results suggest that preoperative diastolic dysfunction can provide useful information on postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Risk factors of postoperative major adverse cardiac events after radical cystectomy: implication of diastolic dysfunction

Jun

Kim

et al. 2019

Sci Rep

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“…Follow-up included duplex ultrasound until 2 years of follow-up. The primary outcome was long-term MACE, defined as a composite outcome of non-fatal MI, AHF (onset of or de novo AHF), and all-cause mortality [6]. Secondary outcomes included all-cause mortality, stroke, MI, AHF, and major adverse limb events (MALE; defined as a composite outcome of major ischemic amputation, acute limb ischemia, and need for peripheral revascularization) [16].…”

Section: Methodsmentioning

confidence: 99%

“…The necessary sample for a survival test was calculated using WinPepi® v.11.65, aiming for statistical power (β) of 80% and a statistical significance of α <0.05. The described MACE rate in long-term post-CEA patients is approximately 6% [6]. The described event rates after 5 years of follow-up in stroke patients with normal and increased RDW-CV varies between 49 and 69% and 69 and 88%, respectively [17, 18].…”

Section: Methodsmentioning

confidence: 99%

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Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Gamas

Jácome

Fragão-Marques

et al. 2020

Cerebrovasc Dis Extra

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Objective: Patients submitted to carotid artery endarterectomy (CEA) have a long-term risk of major adverse cardiovascular events (MACE) of 6–9% at 2 years. Hematological parameters have been shown to have a predictive function in atherosclerotic diseases, namely the red blood cell distribution width-coefficient of variation (RDW-CV). This parameter has been associated with worse outcomes such as myocardial infarction (MI), stroke, and all-cause mortality. This study aims to evaluate the potential role of preoperative hematologic parameters such as RDW-CV in predicting perioperative and long-term cardiovascular adverse events and mortality in patients submitted to CEA. Methods: From January 2012 to January 2019, 180 patients who underwent CEA with regional anesthesia in a tertiary care and referral center were selected from a prospective cohort database. Blood samples were collected preoperatively 2 weeks before admission, including a full blood count. The primary outcome included long-term MACE. Secondary outcomes included all-cause mortality, stroke, MI, acute heart failure, and major adverse limb events (MALE). Results: At baseline, 27.2% of patients had increased RDW-CV. Increased RDW-CV was independently associated with baseline hemoglobin (adjusted odds ratio [aOR] 0.715, 95% CI 0.588–0.869, p = 0.001) and atrial fibrillation (aOR 4.028, 95% CI 1.037–15.639, p = 0.001). After a median follow-up of 50 months, log-rank univariate analysis of RDW-CV demonstrated a significant association between increased RDW-CV and long-term all-cause mortality (log-rank <0.001), MACE (log-rank <0.001), and MI (log-rank = 0.017). After multivariate Cox regression analysis, increased RDW-CV was associated with increased long-term mortality (adjusted hazard ratio [aHR] 2.455, 95% CI 1.231–4.894, p = 0.011) and MACE (aHR 2.047, 95% CI 1.202–3.487, p = 0.008). A decreased hemoglobin to platelet ratio (aHR 2.650e–8, 95% CI 9.049e–15 to 0.078, p = 0.019) was also associated with all-cause mortality. Conclusion: RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.

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“…(2016) выявили, что у 15,1% пациентов, которым была выполнена КЭЭ под ОА, отмечалось повышение уровня тропонина I в первые трое суток после операции, а инфаркт миокарда в первые 30 дней развился у 3,6% [28]. Таким образом, клинически подтвержденный инфаркт миокарда наблюдался лишь у 23,5% пациентов с повышенным уровнем тропонина I после операции под ОА [28]. J. Pereira-Macedo и соавт.…”

Section: Discussionunclassified

Regional Anesthesia for Carotid Endarterectomy in Patients with Acute Ischemic Stroke (Pilot Study)

Симонов

Pryamikov

Loluev

et al. 2022

Obŝaâ reanimatologiâ

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Objective. The aim of this study is to assess the safety of the use of regional anesthesia for performing carotid endarterectomy (CEA) in patients in the acute phase of ischemic stroke.Material and methods. The study included 66 patients in the acute phase of ischemic stroke (atherothrom-botic subtype according to the TOAST classification) who underwent carotid endarterectomy. The inclusion criteria for the study were as follows: acute phase of atherothrombotic ischemic stroke (first 28 days), ipsilateral symptomatic ≥ 50% stenosis of the internal carotid artery, 1-4 points neurological deficit according to the modified Rankin Scale (mRS), 1-13 points neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), size of the cerebral ischemic lesion ≤ 4 cm. This single-center prospective cohort study compared two anesthetic approaches, regional anesthesia (RA, 46 patients) and general anesthesia (GA, 20 patients). The RA techniques included ultrasound-guided superficial and deep cervical plexus blocks on the side of the surgery.Results. The study found no significant differences in the baseline patient characteristics, surgery techniques and clinical outcomes between the groups. There were no neurological or cardiovascular toxic reactions to the local anesthetics. Conversions from RA to GA were not performed. In the RA group, recurrent ipsilateral ischemic strokes, myocardial infarctions, wound hemorrhagic complications and lethal outcomes did not occur.Conclusion. This pilot study has demonstrated the safety of RA for performing CEA in patients in the acute phase of ischemic stroke. RA provides adequate neuromonitoring and timely intraoperative recognition of «new» ischemic complications. To compare the efficacy of RA and GA for performing CEA in patients with acute ischemic stroke, large randomized controlled trials are needed.

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Clinical Relevance of Cardiac Troponin Assessment in Patients Undergoing Carotid Endarterectomy

Abstract: Troponin elevation after CEA occurred in 15% of patients. The incidence of adverse cardiovascular events was significantly higher in patients with troponin elevation, which was mainly attributable to silent non-ST segment elevation MIs that occurred in the early post-operative phase.

Cited by 21 publications

References 24 publications

Risk factors of postoperative major adverse cardiac events after radical cystectomy: implication of diastolic dysfunction

Risk factors of postoperative major adverse cardiac events after radical cystectomy: implication of diastolic dysfunction

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy

Regional Anesthesia for Carotid Endarterectomy in Patients with Acute Ischemic Stroke (Pilot Study)

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