ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Myocardial injury after aortoiliac revascularization for extensive disease: A survival analysis
Juliana Pereira-Macedo1, Neuza Machado1, António Pereira-Neves1,2,3, Vítor Ferreira4, José Oliveira-Pinto1,3, Marina Dias-Neto1,3, João Rocha-Neves1,2,3, José Teixeira1, José Andrade1,5
1Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
2Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
3Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
4Department of Angiology and Vascular Surgery, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
5Center for Health Technology and Services Research, CINTESIS, Porto, Portugal
DOI : 10.5606/tgkdc.dergisi.2020.20100
Background: This study aims to evaluate the incidence of myocardial injury after non-cardiac surgery for an extensive disease pattern (TASC II type D) and to examine its prognostic value.

Methods: This prospective study included a total of 66 consecutive patients (62 males, 4 females; mean age 62.5±8.2 years) who underwent elective revascularization for aortoiliac TASC II type D lesions in the tertiary setting between January 2013 and March 2019. The patients were scheduled for revascularization either by open surgery or endovascular approach. Cardiac troponins were routinely measured in the postoperative period. Myocardial injury after non-cardiac surgery was defined as the elevation of cardiac troponin for at least one value above the 99th percentile upper reference limit. Myocardial infarction, acute heart failure, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality were assessed both postoperatively and during follow-up.

Results: The incidence of myocardial injury after non-cardiac surgery was 25.8%. In the multivariate analysis, chronic heart failure was found to be a significant risk factor for myocardial injury after non-cardiac surgery (odds ratio: 10.3; 95% confidence interval 1.00-106.8, p=0.018). At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality. At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction (log-rank p=0.002), stroke (log-rank p=0.007), major adverse cardiovascular events (log-rank p=0.000), major adverse limb events (log-rank p=0.007), and all-causemortality (log-rank p=0.000).

Conclusion: Our study results suggest that myocardial injury after non-cardiac surgery plays a role as a predictor of significant cardiovascular comorbidities and mortality after complex aortoiliac revascularization. The presence of chronic heart failure is also associated with a higher incidence of myocardial injury after aortoiliac TASC II type D revascularization. Therefore, preemptive strategies should be adopted to identify and treat these patients.

Keywords : Aortoiliac revascularization, major adverse cardiovascular events, major adverse limb events, myocardial injury after non-cardiac surgery
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