SS20. Asymptomatic Perioperative Myocardial Damage is Associated with Poor Long-term Outcome after Vascular Surgery

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• Background
• Aim
• Methods
• Results
• Conclusions
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Background 

Cardiac troponin T (cTnT) release is a sensitive marker for myocardial injury and occurs frequently after vascular surgery. However, the prognosis of cTnT elevations without clinical symptoms and/or new electrocardiographic changes (asymptomatic cTnT release) is unknown.

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Aim 

To assess the long-term prognosis of vascular surgery patients who experience perioperative asymptomatic myocardial damage.

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Methods 

A total of 1545 patients undergoing elective vascular surgery were enrolled. Baseline characteristics and medication were noted. Routine sampling of cTnT and ECG recording was performed on day 1, 3, and 7 after surgery and at the day of discharge. Elevated cTnT was defined as serum concentrations ≥ 0.01 ng/ml. The mean follow-up was 3.7 years and mortality was noted.

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Results 

A total of 213 (14%) patients experienced asymptomatic cTnT release, median 0.08 ng/ml (IQR 0.04-0.20 ng/ml), while 71 (5%) patients had symptomatic cTnT release. During follow-up 304 patients (20%) died. Mortality was higher in patients with asymptomatic cTnT release compared to patients without cTnT release (13% vs. 40%; p<0.001, figure). After adjustment for risk factors and type and site of surgery, the association between asymptomatic elevated cTnT levels and increased late mortality persisted (adjusted HR 2.3; 95% CI 1.8-3.0) and risk increased with higher cTnT levels (HR 1.64 for every 0.10 ng/ml increase, p=0.02). Elevated cTnT had prognostic value irrespective of baseline creatinine value or renal dysfunction after surgery.

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Conclusions 

Asymptomatic cTnT release, without clinical symptoms or new ECG changes, is associated with an increased long-term mortality in patients undergoing vascular surgery.