Abstract | BACKGROUND: 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.
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Authors | Arnaud Foucrier, Reitze Rodseth, Mohamed Aissaoui, Cristina Ibanes, Jean-Pierre Goarin, Paul Landais, Pierre Coriat, Yannick Le Manach |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 119
Issue 5
Pg. 1053-63
(Nov 2014)
ISSN: 1526-7598 [Electronic] United States |
PMID | 24937347
(Publication Type: Journal Article, Observational Study)
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Chemical References |
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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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