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Published on: September 22, 2020
Myocardial injury after endovascular revascularization in critical limb ischemia predicts 1-year mortality: a
Wojciech Szczeklik1,2, Marek Krzanowski3,4, Paweł Maga3,4
1Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland. wojciech.szczeklik@uj.edu.pl.
Insights
Myocardial injury is common after endovascular revascularization for critical limb ischemia (CLI). This injury significantly increases the risk of 1-year mortality and major adverse cardiovascular events (MACE).
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Interventional Cardiology
Background:
- Patients with critical limb ischemia (CLI) face elevated risks of cardiovascular complications and mortality.
- Endovascular revascularization is a common treatment for CLI, but potential cardiac complications require investigation.
Purpose of the Study:
- To determine the incidence of myocardial injury following endovascular revascularization in CLI patients.
- To assess the relationship between myocardial injury and 1-year mortality and major adverse cardiovascular events (MACE).
Main Methods:
- A prospective cohort study included 239 CLI patients (≥45 years) undergoing endovascular revascularization.
- High-sensitive troponins T (hsTnTs) were measured serially; myocardial injury was defined as hsTnT ≥ 14 ng/L with a ≥30% relative increase.
- Outcomes including 1-year mortality and MACE were tracked.
Main Results:
- Myocardial injury occurred in 25.5% of patients (61/239) using the defined hsTnT threshold.
- Myocardial injury was independently associated with increased 1-year mortality (aHR 2.44-3.34) and MACE (AOR 2.89-6.69) across different hsTnT thresholds.
- 85.2% of patients with myocardial injury showed no typical ischemic symptoms or ECG changes.
Conclusions:
- Myocardial injury is a frequent complication after endovascular revascularization for CLI.
- The presence of myocardial injury post-procedure is a significant independent predictor of adverse cardiovascular outcomes, including mortality and MACE within one year.
Background:
Patients with critical limb ischemia (CLI) are at increased risk of cardiovascular complications and mortality. To determine (1) incidence of myocardial injury following endovascular revascularization, and (2) relationship between myocardial injury with 1-year mortality and major adverse cardiovascular events (MACE; i.e., composite of myocardial infarction, stroke, and death).
Methods And Results:
Single-center, prospective cohort study of CLI patients ≥ 45 years of age, who underwent endovascular revascularization with overnight hospitalization. High-sensitive troponins T (hsTnTs) were measured on admission, 3-6 h after endovascular revascularization and the subsequent morning. Myocardial injury after endovascular revascularization was defined as an hsTnT ≥ 14 ng/L with a relative increase ≥ 30% from the baseline value. We also evaluated other myocardial injury hsTnT thresholds (i.e., ≥ 30, ≥ 40, ≥ 60, and ≥ 80 ng/L). 239 consecutive patients (56% male, mean age 71.5 ± 10.1 years) were included; one patient was lost to follow-up. At 1 year, there were 34 deaths (14.2%), and 48 MACE (20.5%). Myocardial injury with the hsTnT threshold of 14 ng/L and relative increase by ≥ 30% from the baseline level occurred in 61 patients (25.5%). Myocardial injury was independently associated with 1-year mortality ([aHR], 2.44; 95% CI 1.18-5.06, for hsTnT ≥ 14 ng/L to aHR, 3.34; 95% CI 1.29-8.65 for hsTnT ≥ 80 ng/L). Myocardial injury was also independently associated with 1-year MACE ([AOR] 2.89; 95% CI 1.41-5.92 for hsTnT ≥ 14 ng/L to AOR, 6.69; 95% CI 2.17-20.68 for hsTnT ≥ 80 ng/L). 85.2% patients who had myocardial injury did not have ischemic clinical symptoms or electrocardiography changes. In sensitive analysis with exclusion of symptomatic patients that developed myocardial injury for the hsTnT ≥ 14 ng/L threshold, both the 1-year mortality (aHR: 2.19; CI 1.02-4.68; p = 0.04), and 1-year MACE (OR 2.25; CI 1.06-4.77; p = 0.036) remained significant.
Conclusions:
Myocardial injury is common following endovascular revascularization for CLI and associated with the risk of 1-year mortality and MACE.
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