Juliana Pereira-Macedo1, Neuza Machado1, António Pereira-Neves1,2,3, Vítor Ferreira4, José Oliveira-Pinto1,3, Marina Dias-Neto1,3, João Rocha-Neves1,2,3, José Teixeira1, José Andrade1,3. 1. Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal. 2. Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal. 3. Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Department of Angiology and Vascular Surgery, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
Abstract
BACKGROUND: This study aims to evaluate the incidence of myocardial injury after non-cardiac surgery for an extensive disease pattern (TASC II type D) and to examine its prognostic value. METHODS: This prospective study included a total of 66 consecutive patients (62 males, 4 females; mean age 62.5±8.2 years) who underwent elective revascularization for aortoiliac TASC II type D lesions in the tertiary setting between January 2013 and March 2019. The patients were scheduled for revascularization either by open surgery or endovascular approach. Cardiac troponins were routinely measured in the postoperative period. Myocardial injury after non-cardiac surgery was defined as the elevation of cardiac troponin for at least one value above the 99th percentile upper reference limit. Myocardial infarction, acute heart failure, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality were assessed both postoperatively and during follow-up. RESULTS: The incidence of myocardial injury after non-cardiac surgery was 25.8%. In the multivariate analysis, chronic heart failure was found to be a significant risk factor for myocardial injury after non-cardiac surgery (odds ratio: 10.3; 95% confidence interval 1.00-106.8, p=0.018). At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality. At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction (log-rank p=0.002), stroke (log-rank p=0.007), major adverse cardiovascular events (log-rank p=0.000), major adverse limb events (log-rank p=0.007), and all-causemortality (log-rank p=0.000). CONCLUSION: Our study results suggest that myocardial injury after non-cardiac surgery plays a role as a predictor of significant cardiovascular comorbidities and mortality after complex aortoiliac revascularization. The presence of chronic heart failure is also associated with a higher incidence of myocardial injury after aortoiliac TASC II type D revascularization. Therefore, preemptive strategies should be adopted to identify and treat these patients.
BACKGROUND: This study aims to evaluate the incidence of myocardial injury after non-cardiac surgery for an extensive disease pattern (TASC II type D) and to examine its prognostic value. METHODS: This prospective study included a total of 66 consecutive patients (62 males, 4 females; mean age 62.5±8.2 years) who underwent elective revascularization for aortoiliac TASC II type D lesions in the tertiary setting between January 2013 and March 2019. The patients were scheduled for revascularization either by open surgery or endovascular approach. Cardiac troponins were routinely measured in the postoperative period. Myocardial injury after non-cardiac surgery was defined as the elevation of cardiac troponin for at least one value above the 99th percentile upper reference limit. Myocardial infarction, acute heart failure, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality were assessed both postoperatively and during follow-up. RESULTS: The incidence of myocardial injury after non-cardiac surgery was 25.8%. In the multivariate analysis, chronic heart failure was found to be a significant risk factor for myocardial injury after non-cardiac surgery (odds ratio: 10.3; 95% confidence interval 1.00-106.8, p=0.018). At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality. At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction (log-rank p=0.002), stroke (log-rank p=0.007), major adverse cardiovascular events (log-rank p=0.000), major adverse limb events (log-rank p=0.007), and all-causemortality (log-rank p=0.000). CONCLUSION: Our study results suggest that myocardial injury after non-cardiac surgery plays a role as a predictor of significant cardiovascular comorbidities and mortality after complex aortoiliac revascularization. The presence of chronic heart failure is also associated with a higher incidence of myocardial injury after aortoiliac TASC II type D revascularization. Therefore, preemptive strategies should be adopted to identify and treat these patients.
Authors: Willem-Jan Flu; Jan-Peter van Kuijk; Sanne E Hoeks; Ruud Kuiper; Olaf Schouten; Dustin Goei; Abdou Elhendy; Hence J M Verhagen; Ian R Thomson; Jeroen J Bax; Lee A Fleisher; Don Poldermans Journal: Anesthesiology Date: 2010-06 Impact factor: 7.892
Authors: Jacek Górka; Kamil Polok; Jakub Fronczek; Karolina Górka; Mateusz Kózka; Paweł Iwaszczuk; Marzena Frołow; P J Devereaux; Bruce Biccard; Jacek Musiał; Wojciech Szczeklik Journal: Eur J Vasc Endovasc Surg Date: 2018-03-23 Impact factor: 7.069
Authors: Wojciech Szczeklik; Marek Krzanowski; Paweł Maga; Łukasz Partyka; Jolanta Kościelniak; Paweł Kaczmarczyk; Mikołaj Maga; Patrycja Pieczka; Anna Suska; Agnieszka Wachsmann; Jacek Górka; Bruce Biccard; P J Devereaux Journal: Clin Res Cardiol Date: 2017-11-24 Impact factor: 5.460