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The long-term impact of early cardiovascular therapy intensification for postoperative troponin elevation after major vascular surgery.

AbstractBACKGROUND:
Acute cardiac events are a frequent cause of morbidity after vascular surgery. The impact of early evidence-based treatment for patients with an acute cardiac event after vascular surgery on long-term postoperative outcomes has not been extensively studied. We hypothesized that providing appropriate evidence-based treatment to patients with elevated postoperative cardiac troponin levels may limit long-term mortality.
METHODS:
We conducted a study of 667 consecutive major vascular surgery patients with an elevated postoperative troponin I level. We then determined which of these patients received medical therapy as per the 2007 American College of Cardiology/American Heart Association recommendations for the medical management of patients with chronic stable angina. All patients with troponin elevation were then matched with 2 control patients without postoperative troponin elevation. Matching was done using logistic regression and nearest-neighbor matching methods. The primary study end point was 12 months survival without a major cardiac event (i.e., death, myocardial infarction, coronary revascularization, or pulmonary edema requiring hospitalization).
RESULTS:
Therapy was intensified in 43 of 66 patients (65%) who suffered a troponin I elevation after surgery. Patients with a troponin I elevation not receiving intensified cardiovascular treatment had a hazard ratio (HR) of 1.77 (95% confidence interval (CI), 1.13-2.42; P = 0.004) for the primary study outcome as compared with the control group. In contrast, patients with a troponin I elevation who received intensified cardiovascular treatment had an HR of 0.63 (95% CI, 0.10-1.19; P = 0.45) for the primary outcome as compared with the control group. Patients with a troponin I elevation not receiving treatment intensification likely were at higher risk for a major cardiac event (HR, 2.80; 95% CI, 1.05-24.2; P = 0.04) compared with patients who did receive treatment intensification.
CONCLUSIONS:
The main finding of this study was that in patients with elevated troponin I levels after noncardiac surgery, long-term adverse cardiac outcomes may likely be improved by following evidence-based recommendations for the medical management of acute coronary syndromes.
AuthorsArnaud Foucrier, Reitze Rodseth, Mohamed Aissaoui, Cristina Ibanes, Jean-Pierre Goarin, Paul Landais, Pierre Coriat, Yannick Le Manach
JournalAnesthesia and analgesia (Anesth Analg) Vol. 119 Issue 5 Pg. 1053-63 (Nov 2014) ISSN: 1526-7598 [Electronic] United States
PMID24937347 (Publication Type: Journal Article, Observational Study)
Chemical References
  • Troponin
Topics
  • Acute Coronary Syndrome (therapy)
  • Aged
  • Aorta (surgery)
  • Case-Control Studies
  • Critical Care (methods)
  • Endpoint Determination
  • Evidence-Based Medicine
  • Female
  • Guidelines as Topic
  • Humans
  • Male
  • Middle Aged
  • Perioperative Care
  • Postoperative Complications (blood, mortality, therapy)
  • Retrospective Studies
  • Survival Analysis
  • Troponin (blood)
  • Vascular Surgical Procedures (adverse effects, mortality)

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