Skip Navigation


European Heart Journal Advance Access originally published online on July 29, 2005
European Heart Journal 2005 26(22):2448-2456; doi:10.1093/eurheartj/ehi430
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
26/22/2448    most recent
ehi430v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in EHJ
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (19)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Bursi, F.
Right arrow Articles by Jaffe, A. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bursi, F.
Right arrow Articles by Jaffe, A. S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation

Francesca Bursi1, Luciano Babuin2, Andrea Barbieri1, Luigi Politi1, Mauro Zennaro1, Teresa Grimaldi1, Antonio Rumolo3, Mauro Gargiulo3, Andrea Stella3, Maria Grazia Modena1 and Allan S. Jaffe2,*

1Institute of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University School of Medicine, Italy
2Cardiovascular Diseases and Department of Laboratory Medicine and Pathology, Gonda 5, 200 First Street SW, Mayo Clinic, Rochester, MN, USA
3Institute of Vascular Surgery, Policlinico Hospital, Modena and Reggio Emilia University School of Medicine, Italy

Received 10 April 2005; revised 6 June 2005; accepted 30 June 2005; online publish-ahead-of-print 29 July 2005.

* Corresponding author. Tel: +1 507 284 3680; fax: +1 507 266 0228. E-mail address: jaffe.allan{at}mayo.edu

See page 2358 for the editorial comment on this article (doi:10.1093/eurheartj/ehi510)

Aims The objectives of this study are to evaluate the prognostic role of pre-operative stratification in patients undergoing elective major vascular surgery, the timing of adverse outcomes, and the predictive role of troponin (cTn).

Methods and results Consecutive vascular surgery candidates (n=391) were prospectively stratified and treated according to the ACC/AHA guidelines. The patients were categorized into three groups: (1) with coronary revascularization in the past 5 years, (2) with intermediate clinical risk predictors, and (3) with minor or no clinical risk predictors. cTnI was measured post-operatively. By 18 months, 18.7% of subjects had experienced death or acute myocardial infarction (MI) (by the ACC/ESC criteria). The hazard ratio (HR) was 5.21 (95% CI=2.60–10.43; P<0.0001) in group 1 and 2.58 (95% CI=1.27–4.38; P=0.004) in group 2 when compared with group 3. Most events occurred within 30 days. Elevations of cTnI were associated with adverse outcomes even after multivariable adjustment at long-term (adjusted overall HR=4.73, 95% CI=2.92–7.65; P<0.0001) and at 30 days (adjusted HR=5.52, 95%CI=3.23–9.42; P<0.0001).

Conclusion After pre-operative stratification, patients undergoing elective major vascular surgery remain at high risk of MI and death. Events occur mainly early after surgery. cTnI elevations are frequent and independently associated with increased risk. These findings suggest the need for a major re-evaluation of our approach to these patients.

Key Words: Troponin • Vascular surgery • Risk stratification


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in EHJ:

Should the ACC/AHA guidelines be changed in patients undergoing vascular surgery?
Sanne E. Hoeks, Jeroen J. Bax, and Don Poldermans
EHJ 2005 26: 2358-2360. [Extract] [Full Text]  



This article has been cited by other articles:


Home page
 Canadian J. AnesthesiaHome page
M.-C. Parent and S. Rinfret
The unresolved issues with risk stratification and management of patients with coronary artery disease undergoing major vascular surgery: [Questions non resolues concernant la stratification du risque et la prise en charge des patients atteints de maladie coronarienne subissant une chirurgie vasculaire majeure]
Can J Anesth, August 1, 2008; 55(8): 542 - 556.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
K. Thygesen, J. S. Alpert, A. S. Jaffe, H. D. White, and on behalf of the Joint ESC/ACCF/AHA/WHF Task Force
Reply.
J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1826 - 1827.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
K. Thygesen, J. S. Alpert, A. S. Jaffe, H. D. White, and On behalf of the Joint ESC/ACCF/AHA/WHF Task Force
Intraoperative myocardial infarction in non-cardiac surgery: is a universal definition feasible? reply
Eur. Heart J., February 2, 2008; 29(4): 567 - 568.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. O. McFalls, H. B. Ward, T. E. Moritz, F. S. Apple, S. Goldman, G. Pierpont, G. C. Larsen, B. Hattler, K. Shunk, F. Littooy, et al.
Predictors and outcomes of a perioperative myocardial infarction following elective vascular surgery in patients with documented coronary artery disease: results of the CARP trial
Eur. Heart J., February 1, 2008; 29(3): 394 - 401.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
E. Mahla, M. Vicenzi, W. Toller, B. H. Cuthbertson, and (on behalf of the authors)
B-type natriuretic peptide in high-risk major surgery patients
Br. J. Anaesth., November 1, 2007; 99(5): 746 - 747.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242.
[Full Text] [PDF]

Home page
 CirculationHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Circulation, October 23, 2007; 116(17): e418 - e500.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
G. Landesberg, Y. Berlatzky, M. Bocher, R. Alcalai, H. Anner, T. Ganon-Rozental, M. H. Luria, I. Akopnik, C. Weissman, and M. Mosseri
A clinical survival score predicts the likelihood to benefit from preoperative thallium scanning and coronary revascularization before major vascular surgery
Eur. Heart J., March 1, 2007; 28(5): 533 - 539.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
G. M. Howard-Alpe, J. W. Sear, and P. Foex
Methods of detecting atherosclerosis in non-cardiac surgical patients; the role of biochemical markers
Br. J. Anaesth., December 1, 2006; 97(6): 758 - 769.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S. E. Hoeks, J. J. Bax, and D. Poldermans
Should the ACC/AHA guidelines be changed in patients undergoing vascular surgery?
Eur. Heart J., November 2, 2005; 26(22): 2358 - 2360.
[Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.