Myocardial Injury is More Common than Deep Venous Thrombosis after Vascular Surgery and is Associated with a High One Year Mortality Risk

Eur J Vasc Endovasc Surg. 2018 Aug;56(2):264-270. doi: 10.1016/j.ejvs.2018.02.005. Epub 2018 Mar 23.

Abstract

Objective/background: Venous thromboembolism (VTE) has been considered the dominant major life threatening vascular complication after non-cardiac surgery, but recent studies have shifted the emphasis toward myocardial injury after non-cardiac surgery (MINS) as a common adverse event in the peri-operative setting. The aim of the present study was to compare the incidence and influence on mortality of two dominant venous and arterial events in the peri-operative period by prospectively screening a consecutive cohort of patients undergoing vascular surgery.

Methods: This was a sub-study of Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION), the main objective of which was to evaluate major peri-operative complications after non-cardiac surgery. Patients undergoing vascular surgery had their blood collected to measure the Roche fifth generation high sensitivity troponin T (hsTnT) assay before and four times after surgery (6-12 h post-operatively, on the first, second, and third day following the procedure). MINS was defined as an elevated post-operative hsTnT ≥65 ng/L or an hsTnT ≥20 to <65 ng/L with an absolute change of ≥5 ng/L that was judged to be due to ischaemia. All patients underwent ultrasound venous compression testing for deep vein thrombosis (DVT) before, 4, and 7 days after surgery and follow-up was performed by telephone 30 days and 1 year after surgery.

Results: In total, 164 consecutive patients were included in this sub-study. MINS was diagnosed in 39 patients (23.8%) and DVT in four patients (2.4%). The 1 year mortality was higher in MINS (9/39 [23.1%]) than non-MINS patients (9/125 [7.2%]; p = .006). None of the patients who developed DVT died in the first year after surgery.

Conclusion: MINS is a common complication after vascular surgery. It occurs more frequently than DVT and is associated with high 1 year mortality.

Keywords: Myocardial ischaemia; Prognosis; Vascular surgical procedures; Venous thromboembolism.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Female
  • Heart Diseases / diagnosis
  • Heart Diseases / mortality*
  • Heart Diseases / pathology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardium / metabolism
  • Myocardium / pathology*
  • Poland / epidemiology
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Troponin T / blood
  • Ultrasonography
  • Vascular Surgical Procedures / adverse effects
  • Vascular Surgical Procedures / mortality*
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / mortality*

Substances

  • Biomarkers
  • Troponin T