Abstract 3517: Long-Term Prognosis of Vascular Surgery Patients Using Perioperative Troponin T Release: Is there a Threshold?
Background: Debate surrounds the impact of renal function on the prognostic value of minor troponin T release in vascular surgery patients. Objective of this study was to assess the long-term prognostic value of minor degrees of troponin T release in patients undergoing major vascular surgery, especially in those with concomitant renal dysfunction.
Methods and results: Survivors of major non-cardiac vascular surgery (n=558) were preoperatively screened for cardiac risk factors and renal function. Serial troponin T was measured on day 1, 3, and 7 after surgery, using a threshold of 0.03 ng/ml. All-cause mortality and major adverse cardiac events (MACE) were noted during follow-up (mean: 3.5 ± 2.0 years). Minor (0.03–0.09 ng/ml) and major (≥0.1 ng/ml) release of troponin T was observed in 4.5% and 8.2%, respectively. During follow-up, 21% of the patients died and 15% experienced MACE. After adjustment for estimated glomerular filtration rate, patients with minor and major troponin T release were both at comparable increased risk for late mortality (HR: 3.43, 95% CI: 1.79–6.58, HR: 3.72, 95% CI: 2.37–5.85, respectively), and MACE (HR: 5.47, 95% CI: 2.60–11.48, HR: 6.32, 95% CI: 3.82–10.48, respectively), compared to patients with troponin T release <0.03 ng/ml. Tests for heterogeneity revealed that both minor and major troponin T release have prognostic value across the entire spectrum of renal function.
Conclusion: Marginal elevations of troponin T strongly predict late mortality and MACE after major vascular surgery, irrespective or renal function. A currently underestimated high-risk subgroup of patients may be identified by using a lower troponin T threshold level.