Outcomes in vascular surgical patients with isolated postoperative troponin leak: a meta-analysis

Although peri-operative myocardial infarction remains a significant cause of morbidity and mortality following vascular surgery, the significance of an isolated troponin leak is uncertain. This is an elevation of troponin below the diagnostic threshold for a peri-operative myocardial infarction, without symptoms or ischaemic electrocardiography changes or echocardiography signs such as new regional wall motion abnormalities. This meta-analysis aimed to determine the early (< 30 days) and intermediate (< 180 days) outcomes of vascular surgical patients with an isolated troponin leak. A full literature search up to December 2010 identified 593 studies, of which nine (consisting of eight distinct patient cohorts) underwent analysis. An isolated troponin leak was strongly predictive of all-cause mortality at 30 days (OR 5.03, 95% CI 2.88-8.79, p < 0.00001). The associated 30-day mortality in patients with no troponin elevation, an isolated troponin leak or peri-operative myocardial infarction was 2.3%, 11.6% and 21.6%, respectively (p = 0.000001). Insufficient data were available to analyse intermediate-term outcomes. An isolated troponin leak following vascular surgery is strongly associated with short-term mortality.