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THE ASSOCIATION BETWEEN PERI-OPERATIVE CARDIAC TROPONINS AND CUMULATIVE MORBIDITY AT THIRTY DAYS IN VASCULAR SURGERY PATIENTS.
THE ASSOCIATION BETWEEN PERI-OPERATIVE CARDIAC TROPONINS AND CUMULATIVE MORBIDITY AT THIRTY DAYS IN VASCULAR SURGERY PATIENTS.
- Source :
- Journal of Cardiothoracic & Vascular Anesthesia; Dec2024:Supplement, Vol. 38 Issue 12, p75-76, 2p
- Publication Year :
- 2024
-
Abstract
- Objective: Peri-operative myocardial injury (PMI) is common after non-cardiac surgery. Myocardial injury after non-cardiac surgery (MINS) describes patients with PMI who do not fulfil the definition of myocardial infarction. Existing guidelines recommend measuring peri-operative cardiac troponin levels in at-risk patients undergoing intermediate- or high-risk surgery to identify asymptomatic myocardial injury. The association between peri-operative cardiac troponins and a cumulative post-operative morbidity score, has not yet been described. This study aims to describe the association between peri-operative cardiac troponins, MINS, and cumulative post-operative complications at thirty days after vascular surgery. Design: A retrospective secondary analysis of an observational, single-center, cohort study. Method. All patients admitted for elective vascular surgery between September 2022 and November 2023 were included. High-sensitivity cardiac troponin I (hs-TnI) was obtained pre-operatively and on each of the first three post-operative days. MINS was defined as an absolute peak post-operative increase to more than the 99th percentile upper reference limit (47 ng/L) above pre-operative hs-TnI values. Post-operative complications were graded according to the Clavien-Dindo classification and summarized weighted by severity using the Comprehensive Complication Index (CCI). Outcomes were defined as the association between pre- and post-operative hs-TnI, and CCI. Due to an extremely skewed distribution, CCI was divided into CCI ≤ 26 and CCI >26. CCI >26 corresponds to a cumulated minimal complication burden equivalent to a Clavien-Dindo 3a complication. Multivariable logistic analyses were adjusted for age, smoking, any heart disease (valvular, coronary artery disease or left ventricular failure), renal dysfunction, smoking status, and surgery type. Results: 200 patients vascular surgery patients were included. 31 and 81 patients underwent open and percutaneous central vascular surgery, respectively, and 88 patients underwent open peripheral surgery. 9 patients were excluded from analysis due to missing hs-TnI values. 195 complications occurred in 97 patients [50.8%] of which 41 patients [42.3%] had a CCI >26. 11 patients [12.1%] developed MINS (median of increase 123 ng L-1 [88.5-2152]) of which 5 patients [45%] had a CCI >26. In univariable analyses, neither pre-operative, peak post-operative, nor the difference between the two (delta TnI) was significantly associated with a CCI >26 (odds ratio [OR]=1.008 ((95% confidence interval [CI]: 0.999-1.020), P=0.126), OR=1.000 ((95% CI: 0.999-1.000), P=0.109), OR=1.000 ((95% CI: 0.999-1.000), P=0.118)). There were no significant associations between pre-operative, peak post-operative, or delta TnI, and a CCI >26 in multivariable analyses (OR=1.007 ((95% CI: 0.998-1.020), P=0.205), OR=1.000 ((95% CI: 0.999-1.001), P= 0.251), OR=1.000 ((95% CI: 1.000-1.001), P=0.269)). Univariable analyses showed no significant associations between pre-operative or delta TnI and a CCI >26 among MINS patients (OR=1.022 ((95 % CI: 0.983-1.118), P= 0.404), OR=1.000 ((95% CI: 1.000-1.001), P= 0.390)) or non-MINS patients (OR=1.006 ((95% CI: 0.997-1.018), P= 0.187), OR=0.994 ((95% CI: 0.980-1.005), P= 0.281)). Pre-operative, post-operative, and delta hs-TnI were not associated with severe post-operative complications at thirty days in uni- and multivariable analyses. Larger studies are warranted to further evaluate this association in a larger sample size as our findings are possibly due to a type II error. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10530770
- Volume :
- 38
- Issue :
- 12
- Database :
- Supplemental Index
- Journal :
- Journal of Cardiothoracic & Vascular Anesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 180492156
- Full Text :
- https://doi.org/10.1053/j.jvca.2024.09.117