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Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm a retrospective population-based cohort study.doc

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Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm a retrospective population-based cohort study

Kopolovicetal.CriticalCare2012,16:R147 /content/16/4/R147 RESEARCH OpenAccess Elevatedcardiactroponinintheearlypost- operativeperiodandmortalityfollowingruptured abdominalaorticaneurysm:aretrospective population-basedcohortstudy IlanaKopolovic1,KimberleySimmonds2,ShelleyDuggan3,MarkEwanchuk3,DanielEStollery3and SeanMBagshaw1* Abstract Introduction:Cardiaccomplicationsarepotentiallylife-threateningfollowingemergencyrepairofruptured abdominalaorticaneurysms(rAAA).Ourobjectivesweretodescribetheincidence,riskfactors,cardiacoutcomes andmortalityassociatedwithelevatedcardiac-specifictroponin(cTnI)followingrepairofrAAA.Wehypothesized thatearlypost-operativecTnIelevation(0.15mcg/L)inrAAApatientswouldidentifyahigh-risksubgroupfor cardiovascularcomplicationsandadverseoutcomes. Methods:Thiswasaretrospectivepopulation-basedcohortstudyofallreferralsforemergencyrepairofrAAAin centralandnorthernAlberta,from1January2002to31December2009.Demographic,clinical,physiologicand laboratorydatawereextracted,alongwithcardiac-specificinvestigationsandeventsinthe72hoursfollowing rAAArepair. Results:Intotal,55%ofpatients(n=77/141)hadelevatedcTnI,ofwhich12%(n=9)hadSTsegmentelevation, 23%(n=18)hadSTsegmentdepression,5%(n=4)hadotherECGchanges,and61%(n=47)hadnodiagnostic ECGchanges.ThosewithpositivecTnIweremorelikelytohavecoronaryarterydisease(45.5%vs.23.4%,P=0.01) andhigherAcutePhysiologyandChronicHealthEvaluation(APACHE)IIscores(24.9vs.21.4,n=0.016).cTnI positivepatientsweremorelikelytoreceivevasoactivesupport(58.4%vs.14.1%,P0.001),hadlongerintensive careunit(ICU)lengthsofstay(8(3to11)vs.4(2to9)days,P=0.02)andhigheradjustedin-hospitalmortality (40.3%vs.14.1%;OR4.23;95%CI,1.47to12.1;P=0.007). Conclusions:ElevatedcTnIearlyafterrAAArepairisanindependentpredictorforpost-operativecomplications anddeath. Introduction The development of peri-operative myocardial injury Rupture of an abdominal aortic aneurysm (rAAA) is a has prognostic importance for survivors of emergency life-threatening condition r