Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

Abstract

SummaryAlthough peri-operative myocardial infarction remains a significant cause of morbidity and mortality following vascular surgery, the significance of an isolated troponin leak is uncertain. This is an elevation of troponin below the diagnostic threshold for a peri-operative myocardial infarction, without symptoms or ischaemic electrocardiography changes or echocardiography signs such as new regional wall motion abnormalities. This meta-analysis aimed to determine the early (< 30 days) and intermediate (< 180 days) outcomes of vascular surgical patients with an isolated troponin leak. A full literature search up to December 2010 identified 593 studies, of which nine

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

“…7 The reported incidence of PMI in vascular patients of between 5% and 26.5% 6,16 is comparable to the 24.3% found in our patients. The finding that PMI and a history of congestive cardiac failure were independent predictors of hospital mortality is consistent with the VISION 4 study.…”

“…A meta-analysis 6 showed that an isolated troponin leak was present in 10.2% of vascular surgical patients and 6.3% had a PMI, and both an isolated troponin leak and PMI were associated with an increased 30-day mortality. A peak postoperative troponin I (TnI) level above the URL has been significantly associated with increased mortality at 2.5 years following vascular surgery.…”

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

“…186,187,[207][208][209][210][211][212][213][214][215][216][217][218][219][220] The definition of an abnormal stress echocardiogram in some studies was restricted to the presence of new wall motion abnormalities with stress, indicative of myocardial ischemia, but in others also included the presence of akinetic segments at baseline, indicative of MI. These studies have predominantly evaluated the role of DSE in patients with an increased perioperative cardiovascular risk, particularly those undergoing abdominal aortic or peripheral vascular surgery.…”

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

“…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.…”