Eversion Carotid Endarterectomy: Cardiac Troponin Assessment
Myocardial infarction (MI) is an eversion carotid endarterectomy (eCEA) complication, but most events are unknown, and true incidence and correlation remain controversial. Routine cardiac troponin measurement is a commonly used method for assessing early identification and treatment of MI and stratifying high-risk patients. The aim of the present study is to evaluate the effect of troponin elevation levels following eCEA and to investigate a possible correlation between adverse cardiovascular events and the incidence of postoperative myocardial infarction following emergent vascular surgery. The study included 54 patients who underwent eCEA. High-sensitive troponin I (hsTnI) levels were routinely monitored pre- and postoperatively, with an upper reference range of 34.5 pg/mL for men and 15.6 pg/mL for women. Increases were correlated with demographic and clinical risk factors, as well as clinical or subclinical cardiovascular events. hsTnI was increased in percentage (13%) postoperatively, and non-ST segment elevation MI was diagnosed in eight patients. No patient had clinical symptoms of MI and only two of them presented with simultaneous electrocardiographic changes. Increased levels did not correlate with comorbidities or other surgical risk factors. hsTnI elevation may occur in patients after eCEA and mostly correlates with silent non-ST segment elevation MI that occurred in the early postoperative phase, indicating a possible value as a tool for cardiovascular event diagnosis during the patient's hospitalization.
Keywordsmyocardial injury - myocardial ischemia - cardiac troponin - noncardiac surgery - eversion carotid endarterectomy
T.K. contributed to study design and conception, data analysis and interpretation, critical revisions that are important for the intellectual content, and approval of the final version of the manuscript files submitted to the journal. P.C. contributed to data collection and writing the manuscript. D.T. contributed to data collection and critical revisions that are important for the intellectual content. K.N. contributed to statistical analysis and writing the manuscript.
The author(s) declare(s) that there are patient's consents regarding the publication of this article.
IRB number: 299/02-02-2021.
Artikel online veröffentlicht:
10. März 2022
© 2022. International College of Angiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Andrews N, Jenkins J, Andrews G, Walker P. Using postoperative cardiac troponin-I (cTi) levels to detect myocardial ischaemia in patients undergoing vascular surgery. Cardiovasc Surg 2001; 9 (03) 254-265
- 2 Godet G, Dumerat M, Baillard C. et al. Cardiac troponin I is reliable with immediate but not medium-term cardiac complications after abdominal aortic repair. Acta Anaesthesiol Scand 2000; 44 (05) 592-597
- 3 Godet G, Arhanghelschi I. Cardiac troponin I predicts short-term mortality in vascular surgery patients. Circulation 2003; 107 (18) e125 , author reply e125
- 4 Kim LJ, Martinez EA, Faraday N. et al. Cardiac troponin I predicts short-term mortality in vascular surgery patients. Circulation 2002; 106 (18) 2366-2371
- 5 Oates CP, Naylor AR, Hartshorne T. et al. Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom. Eur J Vasc Endovasc Surg 2009; 37 (03) 251-261
- 6 Roshanov PS, Walsh M, Devereaux PJ. et al. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study. BMJ Open 2017; 7 (01) e013510
- 7 Kotsis T, Christoforou P, Nastos K. Carotid body baroreceptor preservation and control of arterial pressure in eversion carotid endarterectomy. Int J Angiol 2020; 29 (01) 33-38
- 8 Pasupathy S, Tavella R, McRae S, Beltrame JF. Myocardial infarction with non-obstructive coronary arteries - diagnosis and management. Eur Cardiol 2015; 10 (02) 79-82
- 9 Ibanez B, James S, Agewall S. et al; ESC Scientific Document Group. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39 (02) 119-177
- 10 Roffi M, Patrono C, Collet JP. et al; ESC Scientific Document Group. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37 (03) 267-315
- 11 Thygesen K, Alpert JS, Jaffe AS. et al; Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction, Authors/Task Force Members Chairpersons, Biomarker Subcommittee, ECG Subcommittee, Imaging Subcommittee, Classification Subcommittee, Intervention Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, Trials & Registries Subcommittee, ESC Committee for Practice Guidelines (CPG), Document Reviewers. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60 (16) 1581-1598
- 12 Vilela EM, Bastos JC, Rodrigues RP, Nunes JP. High-sensitivity troponin after running–a systematic review. Neth J Med 2014; 72 (01) 5-9
- 13 Kristensen SD, Knuuti J, Saraste A. et al; Authors/Task Force Members. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35 (35) 2383-2431
- 14 Glance LG, Lustik SJ, Hannan EL. et al. The surgical mortality probability model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 2012; 255 (04) 696-702
- 15 Devereaux PJ, Szczeklik W. Myocardial injury after non-cardiac surgery: diagnosis and management. Eur Heart J 2020; 41 (32) 3083-3091
- 16 Devereaux PJ, Biccard BM, Sigamani A. et al; Writing Committee for the VISION Study Investigators. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2017; 317 (16) 1642-1651
- 17 Master AM, Dack S, Jaffe HL. Postoperative coronary artery occlusion. JAMA 1938; 110: 1415-1418
- 18 Puelacher C, Lurati Buse G, Seeberger D. et al; BASEL-PMI Investigators. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization. Circulation 2018; 137 (12) 1221-1232
- 19 Devereaux PJ, Chan MT, Alonso-Coello P. et al; Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA 2012; 307 (21) 2295-2304
- 20 Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S. Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA Cardiol 2017; 2 (02) 181-187