Myocardial injury in patients after an elective abdominal aortic aneurysm repair.

Background: The aim of the study was to study the frequency of cTnI release in patients undergoing an elective abdominal aortic aneurysm repair (AAA) and examine the relationship between an early perioperative myocardial injury, as detected by an increased serum levels of cTnI, and a clinical outcome (postoperative cardiac and non-cardiac complications, mortality).

Methods: A prospective observational study of 90 patients undergoing an elective AAA repair.

Setting: University hospital. Blood samples were obtained from 90 patients for cTnI assays, 8 and 24 hours after surgery.

Results: 74.5 % of patients faced a high and medium perioperative risk (ASA III-IV). Peak postoperative cTnI concentrations above the lower detection limit of the immunoassay occurred in 22 patients. 15 of these patients (cTnI levels: 0.2-10.2 ng/ml) displayed symptoms of clinically significant complications. 9 patients (cTnI levels: 0.48-10.2 ng/ml) had serious complications (3x MI, 3x heart failure, 2x bronchopneumonia - respiratory failure, 1x sepsis), one patient died. Only 5.8 % of patients without cTnI increase had postoperative complications. A Chi-square analysis revealed a significant association between cTi elevation and postoperative complications (chi-square 38.737, p<0.0001).

Conclusions: A quarter of the patients who underwent an elective aortic surgery suffered from myocardial necrosis. A cTnI rise was associated with clinically significant events in 68 %; patients with cTnI release were at a significantly higher risk of cardiac and non-cardiac complications. These data confirm that patients with a postoperative rise in cTnI levels would be classified as patients at a higher risk of complications and a specific cardioprotective treatment, invasive monitoring and a longer ICU stay could be required in these cases (Tab. 6, Ref. 24).