PROGNOSTIC VALUE OF PERIOPERATIVE CARDIAC TROPONIN I COMPARED TO CREATINE KINASE-MB FRACTION AND TO HIGH SENSITIVITY C-REACTIVE PROTEIN IN VASCULAR SURGERY

Abstract

Cardiovascular complications were highest in vascular surgery patients due to the high prevalence of underlying coronary artery disease. It is important to recognize the value of preoperative cardiac assessment because risk stratification may identify patients who are expected to benefit from preoperative evaluation and perioperative care. A systematic review was performed on prediction of Postoperative Cardiac Complications (PCCs) and they reported that it discriminated moderately well between low and high risk for cardiac events but demonstrated less predictive value for PCCs in patients with vascular surgery. Currently, biochemical markers including cardiac Troponin I (cTnI), Creatine Kinase-muscle and brain fraction (CK-MB), high-sensitivity C-reactive protein (hs-CRP) are increasingly used for cardiac risk stratification. The aim of the present study is to evaluate comparatively the prognostic value of cTnI, CK-MB, and hs-CRP for short-term (less than 1 month) cardiovascular mortality and morbidity after non-cardiac vascular surgery. A total of 80 patients of both sexes, aged 50 years old and above, undergoing elective vascular surgeries at Vascular Department of Ain Shams University Hospitals were enrolled in the study and patients were prospectively followed-up over a period of one month. Serial blood samples were drawn from all patients to measure serum cardiac Troponin-I, Creatine Kinase-MB fracrtion, and high sensitivity C-reactive protein preoperatively, 24 hours postoperatively, and whenever clinically indicated in any postoperative cardiac event. The primary endpoint was detecting and comparing acute myocardial infarction, unstable angina, ischemic stroke, and death from cardiac causes.