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The effect of postoperative myocardial ischemia on long-term survival after vascular surgery
Jessica P Simons1, Donald T Baril, Philip P Goodney
1Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
Insights
Postoperative troponin elevation after vascular surgery significantly reduces long-term survival. This finding highlights the need for better patient optimization to improve outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Outcomes Research
Background:
- The long-term survival impact of postoperative troponin elevation after vascular surgery remains unclear.
- This study investigates the association between troponin elevation, myocardial infarction (MI), and long-term survival in vascular surgery patients.
Purpose of the Study:
- To evaluate the impact of postoperative troponin elevation and MI on 5-year survival after major vascular procedures.
- To identify predictors of survival and postoperative myocardial ischemia in this patient cohort.
Main Methods:
- Analysis of a registry of 16,363 patients undergoing carotid revascularization, open or endovascular AAA repair, or infrainguinal bypass (2003-2011).
- Evaluation of the association between postoperative troponin elevation/MI and 5-year survival using multivariable models.
- Assessment of predictors for survival and postoperative myocardial ischemia.
Main Results:
- Postoperative troponin elevation occurred in 1.3% and MI in 1.6% of patients, with higher rates after open AAA repair.
- Any postoperative myocardial ischemia (troponin elevation or MI) predicted reduced 5-year survival (73% vs. 54% vs. 33%, P < .0001).
- Troponin elevation (HR 1.45) and MI (HR 2.9) were independent predictors of reduced 5-year survival.
Conclusions:
- Postoperative troponin elevation and MI are associated with significantly lower 5-year survival following vascular surgery.
- These findings underscore the importance of identifying and optimizing high-risk patients to mitigate adverse long-term outcomes.
- Postoperative troponin elevation may serve as a valuable marker for risk stratification and guiding aggressive patient management.
Introduction:
The impact of a postoperative troponin elevation on long-term survival after vascular surgery is not well-defined. We hypothesize that a postoperative troponin elevation is associated with significantly reduced long-term survival.
Methods:
The Vascular Study Group of New England registry identified all patients who underwent carotid revascularization, open abdominal aortic aneurysm repair (AAA), endovascular AAA repair, or infrainguinal lower extremity bypass (2003-2011). The association of postoperative troponin elevation and myocardial infarction (MI) with 5-year survival was evaluated. Multivariable models identified predictors of survival and of postoperative myocardial ischemia.
Results:
In the entire cohort (n = 16,363), the incidence of postoperative troponin elevation was 1.3% (n = 211) and for MI was 1.6% (n = 264). Incidences differed across procedures (P < .0001) with the highest incidences after open AAA: troponin elevation, 3.9% (n = 74); MI, 5.1% (n = 96). On Kaplan-Meier analysis, any postoperative myocardial ischemia predicted reduced survival over 5 years postoperatively: no ischemia, 73% (standard error [SE], 0.5%); troponin elevation, 54% (SE, 4%); MI, 33% (SE, 4%) (P < .0001). This pattern was observed for each procedure subgroup analysis (P < .0001). Troponin elevation (hazard ratio, 1.45; 95% confidence interval, 1.1-2.0; P = .02) and MI (hazard ratio, 2.9; 95% confidence interval, 2.3-3.8; P < .0001) were independent predictors of reduced survival at 5 years.
Conclusions:
Postoperative troponin elevation and MI predict a 26% or a 55% relatively lower survival in the 5 years following a vascular surgical procedure, respectively, compared with patients who do not experience myocardial ischemia. This highlights the need to better characterize factors leading to postoperative myocardial ischemia. Postoperative troponin elevation, either alone, or in combination with an MI, may be a useful marker for identifying high-risk patients who might benefit from more aggressive optimization in hopes of reducing adverse long-term outcomes.
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