Cardiac Troponin I after Carotid Endarterectomy in Different Cardiac Risk Patients

• Published in: Journal of stroke and cerebrovascular diseases Vol. 24; no. 3; pp. 711 - 717
• Main Authors: Galyfos, George, MD, PhD, Tsioufis, Costas, MD, PhD, Theodorou, Dimitris, MD, PhD, Katsaragakis, Stilianos, MD, PhD, Zografos, Georgios, MD, PhD, Filis, Konstantinos, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2015
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Cardiac damage; cardiac risk index; cardiac troponin I; Cardiovascular; carotid endarterectomy; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - mortality; Female; Greece - epidemiology; Humans; Incidence; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Ischemia - blood; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - mortality; Neurology; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Troponin I - blood; Greece; cardiac risk index; carotid endarterectomy; Cardiac damage; cardiac troponin I
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.024

Background We compared postoperative cardiac damage, defined as cardiac troponin I (cTnI) elevation, in low, medium, and high cardiac risk patients, after carotid endarterectomy (CEA). Methods The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) criteria for stratifying patients considered for vascular surgery into low, medium, and high cardiac risk groups were used prospectively. For all patients (n = 324), cTnI value assessments were made before surgery and on postoperative days 1, 3, and 7. Postoperative cTnI values ranging from .05 to .5 ng/mL were classified as myocardial ischemia; values more than .5 ng/mL were classified as myocardial infarction. Cardiac damage was defined as either myocardial ischemia or infarction. Results Mortality was .003%, stroke rate was null, and symptomatic myocardial infarction was null as well. Low-risk patients (16 of 140) and medium-risk patients (28 of 160) increased their troponin levels on days 1 and 3 postoperatively. However, none of the high-risk patients (n = 24) showed any postoperative cardiac damage. Low and medium cardiac risk patients showed higher troponin values on each separate day, in comparison with high cardiac risk patients. Conclusions CEA is followed by a high incidence of asymptomatic cTnI increase that is associated with late cardiac events. However, high cardiac risk patients as defined by the VSG-CRI criteria do not seem to suffer higher cardiac damage after CEA compared with low and medium cardiac risk patients.