Abstract 20317: Stress-Induced Ischemia Does Not Risk Stratify Patients Prior to Vascular Surgery and is Not Associated With Elevated Post Operative Troponin
Introduction: Imaging-based stress testing is used to risk stratify patients undergoing vascular surgery, though the evidence is limited. We aim to assess whether ischemia provides prognostic value for post-operative events and is associated with elevated troponin.
Methods: Consecutive patients with imaging stress tests prior to vascular surgery were included. Clinical risk was determined by the revised cardiac risk index (RCRI). The primary outcome was post-operative myocardial infarction, heart failure, arrhythmia, or death within 30 days. The secondary outcome was elevated troponin.
Results: Among 688 patients, 7.6% had exercise radionuclide imaging, 14.4% exercise echocardiography, 19.3% dobutamine echocardiography, and 58.7% vasodilator radionuclide imaging. Overall, 21.8% had ischemia. Patients with ischemia were more likely to be male, have CAD, heart failure, and diabetes (Table 1). The primary outcome occurred in 17.2%, and 6.7% had an elevated troponin. Ischemia was not associated with the primary (20.7% v. 16.2%, p=0.22) or secondary outcome (8.7% v. 6.1%, p=0.27). On multivariable analysis, a higher RCRI score and an inability to exercise were associated with the primary outcome while only RCRI was associated with the secondary outcome (Figure 1).
Conclusions: In patients undergoing vascular surgery, stress-induced ischemia did not provide risk stratification for cardiac events. Ischemia was also not associated with elevated troponin, supporting the hypothesis that post-operative troponinemia is often not mediated by severe epicardial stenosis.Table 1. Baseline Characteristics Figure 1. Multivariable logistic regression models
Author Disclosures: A. Gutierrez: None. P. Cremer: None. G. Reed: None. L. Young: None. C. Joshua: None. U. Malik: None. J. Wael: None. V. Menon: None.
- © 2016 by American Heart Association, Inc.