Abstract 11457: Surveillance of Perioperative Myocardial Injury With Cardiac Troponins Influences Medical Management at the Time of Hospital Discharge
Background: Current AHA/ACC guidelines recommend against the use of cardiac troponins (cTn) for the surveillance of perioperative myocardial injury (PMI) in asymptomatic patients. We hypothesized that surveillance of PMI with cTnI would lead to initiation or intensification of medical therapies for coronary artery disease (CAD).
Methods: The Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery (CRIPES, NCT 01558596) is an ongoing prospective, randomized, sham-controlled phase 2 trial using remote ischemic preconditioning prior to elective vascular procedures. The primary efficacy end-point is the proportion with and magnitude of postoperative increases in cTnI. Cardiac troponins, measured before and after surgery, were available to treating clinicians. Increases above ≥ 0.01 μg/L in the perioperative period were considered clinically significant. Intensification of medical therapy was defined as initiation of aspirin (ASA) or initiation/increases in the dose of angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers, statins, or beta-blockers.
Results: Between June 2011 and April 2015, a total of 185 patients (mean age 68±7, 100% male) were enrolled in the trial. A total of 28 patients (15%) had significant increases in cTnI after vascular surgery and 38 (20.5%) had their medical therapies intensified in the perioperative period. Baseline utilization of medical therapies was high: ASA 86%, statins 75%, beta-blockers 65%, ACEI 48%. The most frequent change in medical therapy in the perioperative period was initiation of ASA (9%). Among patients with substantial increases in cTnI 11 (39%) had intensification of medical therapy versus 27 (17%) in patients with no or smaller increases in cTnI (p=0.02). Using logistic regression analysis to control for subject’s age, history of CAD, CHF, diabetes, high-risk surgery, and revised cardiac risk index, a cTnI increase > 0.01 μg/L remained associated with intensification of medical therapy (odds ratio: 3.2, 95% CI: 1.3-8.3. p=0.014).
Conclusions: Among patients undergoing vascular surgery, surveillance of cTn in the perioperative period has value, by altering the clinician’s decisions to either initiate or intensify medical therapies for CAD.
Author Disclosures: M. Zakharova: None. F. Mazzulla: None. T. Rector: None. E.O. McFalls: None. D. Yannopoulos: Research Grant; Modest; Dr Yannopoulos is the PI and co-PI for the following NIH (NHLBI) grants: R01 HL123227, 1R01HL126092 -01, R01HL1223231, R43HL123194-01 1R43HL110517-01A1, R43HL115937-01. Dr Yannopoulos also received fu. E. Brilakis: Research Grant; Modest; research support from the department of Veterans Affairs (PI of the Drug Eluting Stents in Saphenous Vein Graft Angioplasty – DIVA trial and Merit grant – I01-CX000787-01) and from the National Instit. Honoraria; Modest; consulting / honoraria from St Jude Medical, Boston Scientific, Asahi, Janssen, Sanofi, Abbott Vascular, Somahlution, Elsevier, and Terumo. Other; Modest; Wife is an employee of Medtronic. S. Garcia: Research Grant; Modest; VA Office of Research and Development. Consultant/Advisory Board; Modest; Surmodics.
- © 2015 by American Heart Association, Inc.