Elevated cardiac troponin in the early post-operative period and mortality following ruptured abdominal aortic aneurysm: a retrospective population-based cohort study
1 University of Alberta Hospital, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB T6G 2B7, Canada
2 Infectious Disease Epidemiology, Surveillance and Assessment Branch, Community and Population Health Division, Alberta Health & Wellness, 23rd Floor, Telus Plaza NT, 10025 Jasper Avenue, Edmonton, AB T5J 1S6, Canada
3 Grey Nuns Community Hospital, Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 100 Youville Dr W, Edmonton, AB T6L 5X8, Canada
Critical Care 2012, 16:R147 doi:10.1186/cc11461Published: 7 August 2012
Cardiac complications are potentially life-threatening following emergency repair of ruptured abdominal aortic aneurysms (rAAA). Our objectives were to describe the incidence, risk factors, cardiac outcomes and mortality associated with elevated cardiac-specific troponin (cTnI) following repair of rAAA. We hypothesized that early post-operative cTnI elevation (>0.15 mcg/L) in rAAA patients would identify a high-risk subgroup for cardiovascular complications and adverse outcomes.
This was a retrospective population-based cohort study of all referrals for emergency repair of rAAA in central and northern Alberta, from 1 January 2002 to 31 December 2009. Demographic, clinical, physiologic and laboratory data were extracted, along with cardiac-specific investigations and events in the 72 hours following rAAA repair.
In total, 55% of patients (n = 77/141) had elevated cTnI, of which 12% (n = 9) had ST segment elevation, 23% (n = 18) had ST segment depression, 5% (n = 4) had other ECG changes, and 61% (n = 47) had no diagnostic ECG changes. Those with positive cTnI were more likely to have coronary artery disease (45.5% vs. 23.4%, P = 0.01) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (24.9 vs. 21.4, n = 0.016). cTnI positive patients were more likely to receive vasoactive support (58.4% vs. 14.1%, P < 0.001), had longer intensive care unit (ICU) lengths of stay (8 (3 to 11) vs. 4 (2 to 9) days, P = 0.02) and higher adjusted in-hospital mortality (40.3% vs. 14.1%; OR 4.23; 95% CI, 1.47 to 12.1; P = 0.007).
Elevated cTnI early after rAAA repair is an independent predictor for post-operative complications and death.