One Year Follow Up of the TROPonin In CArotid Revascularisation (TROPICAR) Study

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Carotid revascularisation procedures, including carotid endarterectomy (CEA) and carotid artery stenting (CAS), carry risks of peri-operative myocardial injury (MI).
• Understanding the long-term impact of peri-operative myocardial injury (MI) on cardiovascular outcomes after carotid revascularisation is crucial for patient management.

Purpose of the Study:

• To investigate the association between peri-operative myocardial injury (MI) and adverse cardiovascular events, including death, one year after carotid revascularisation.
• To identify predictors of myocardial infarction (MI) within one year following CEA or CAS.

Main Methods:

• A prospective, multicentre cohort study enrolled 527 patients undergoing elective CEA or CAS.
• High-sensitivity cardiac troponin levels were measured pre- and post-operatively.
• Patients were followed for one year, with endpoints including myocardial infarction (MI), stroke, and mortality, analyzed using survival analysis.

Main Results:

• One-year follow-up was completed by 95.8% of patients (n=505).
• The incidence of myocardial infarction (MI) was 2.6% and stroke was 3.8% one year post-operatively.
• Post-operative myocardial injury (MI) and pre-operative malignancy independently predicted 1-year MI (OR=6.54, p=.003 and OR=6.13, p=.006, respectively). MI-free survival was significantly lower in patients with post-operative MI (91.9% vs. 98.2%, p=.003).

Conclusions:

• Post-operative myocardial injury (MI) is an independent predictor of 1-year MI after carotid revascularisation (CEA or CAS).
• Patients experiencing post-operative MI represent a high-risk subgroup.
• Targeted strategies are recommended for this high-risk group to mitigate subsequent cardiac adverse events.