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Kopolovic I, Simmonds K, Duggan S, Ewanchuk M, Stollery DE, Bagshaw SM. Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm: a retrospective population-based cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R147. [PMID: 22871065 PMCID: PMC3580736 DOI: 10.1186/cc11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022]
Abstract
Introduction Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes. Methods This was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair. Results In total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007). Conclusions Elevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.
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Cahill TJ, Bowes P, Duncan E, Drye E, Sen S, Miller C, Reshamwalla S, Andrew C, Ward M, Bakhai A. Risk Stratification by Cardiac Biomarkers following Emergency Gastrointestinal Surgery. ACTA ACUST UNITED AC 2011. [DOI: 10.5402/2011/403130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perioperative cardiac complications are a major cause of death following emergency gastrointestinal surgery. Early diagnosis of subclinical myocardial injury and infarction may be improved by screening with cardiac biomarkers. The aim of this study was to assess the predictive value of troponin I (TnI) and B-type natriuretic peptide (BNP) in the early postoperative period after emergency gastrointestinal surgery. We prospectively recruited 48 patients undergoing major emergency surgery for gastrointestinal or colorectal pathology in a single district general hospital. The primary endpoint was mortality at 90 days following surgery. Overall survival was 81.3% (39/48), with 9 postoperative deaths. Elevated TnI (≥0.03 ng ) was the best predictor of mortality, associated with an odds ratio of death by 90 days of 14.3 (95% CI 1.50–337, ). A postoperative BNP concentration >408.5 pg was associated with an odds ratio of death by 90 days of 13.6 (95% CI 2.03–106, ). A single measurement of postoperative BNP and TnI is a powerful predictor of short- to medium-term mortality in patients after emergency gastrointestinal surgery. Further work is required to demonstrate that cardiac biomarkers have independent predictive power and that patient outcomes can be improved.
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Affiliation(s)
- T. J. Cahill
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - P. Bowes
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - E. Duncan
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - E. Drye
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - S. Sen
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - C. Miller
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
| | - S. Reshamwalla
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - C. Andrew
- Department of Biochemistry, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - M. Ward
- Department of Surgery, Barnet & Chase Farm Hospital NHS Trust, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex EN2 8JL, UK
| | - A. Bakhai
- Department of Cardiology, Barnet & Chase Farm Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, UK
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