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.
Aim
To assess the long-term prognosis of vascular surgery patients who experience perioperative asymptomatic myocardial damage.
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.
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.
Asymptomatic cTnT release, without clinical symptoms or new ECG changes, is associated with an increased long-term mortality in patients undergoing vascular surgery.
1Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
2Leiden University Medical Center, Leiden, Netherlands
Author Disclosures: O. Schouten, None; T.A. Winkel, None; G.M. Welten, None; H. van Urk, None; H.J.M. Verhagen, None; J.J. Bax, None; D. Poldermans, None.
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