Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery
| Autor: | Yacov Berlatzky, Inna Akopnik, Giora Landesberg, Vadim Shatz, Charles Weissman, Yehuda G. Wolf, Morris Mosseri, Michael Mayer |
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| Rok vydání: | 2003 |
| Předmět: |
Adult
Male medicine.medical_specialty Myocardial Ischemia Ischemia Infarction Internal medicine Odds Ratio medicine Creatine Kinase MB Form Humans Postoperative Period Prospective Studies Myocardial infarction Creatine Kinase Survival analysis Aged Aged 80 and over biology business.industry Vascular disease Perioperative Middle Aged medicine.disease Survival Analysis Troponin Isoenzymes Cardiology biology.protein Female Creatine kinase Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Biomarkers |
| Zdroj: | Journal of the American College of Cardiology. 42:1547-1554 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2003.05.001 |
| Popis: | OBJECTIVES The aim of this study was to determine the long-term prognosis with postoperative markers of myocardial ischemia and infarction. BACKGROUND Cardiac troponins (cTn) are superior to creatine kinase-MB fraction (CK-MB) in detecting perioperative myocardial infarction (PMI). However, their threshold levels signifying PMI and their long-term prognostic value are not yet determined. METHODS A cohort of 447 consecutive patients who underwent 501 major vascular procedures was prospectively studied. Perioperative continuous 12-lead electrocardiogram monitoring, cardiac troponin-I (cTn-I) and/or cardiac troponin-T (cTn-T), and CK-MB levels on the first three postoperative days, and long-term survival were determined. The association of different cutoff levels of CK-MB, troponin, and ischemia duration with long-term survival was investigated. RESULTS Between 14 (2.9%) and 107 (23.9%) of the patients sustained PMI, depending on the biochemical criteria used. Elevated postoperative CK-MB, cTn, and prolonged (>30 min) ischemia, at all cutoff levels examined, predicted long-term mortality independent of the preoperative predictors: patient's age, type of vascular surgery, previous myocardial infarction, and renal failure (Cox multivariate analysis). Both CK-MB >10% and cTn-I >1.5 ng/ml and/or cTn-T >0.1 ng/ml independently predicted a 3.75-fold and 2.06-fold increase in long-term mortality (p = 0.006 and 0.012, respectively). Similarly, both CK-MB >5% and cTn-I >0.6 ng/ml and/or cTn-T >0.03 ng/ml independently predicted a 2.15-fold and 1.89-fold increase in mortality (p = 0.018 and 0.01, respectively). Patients with both these markers elevated had a 4.19-fold increase in mortality (p < 0.001). CONCLUSIONS Postoperative CK-MB and troponin, even at low cutoff levels, are independent and complementary predictors of long-term mortality after major vascular surgery. |
| Databáze: | OpenAIRE |
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