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Vascular Medicine, Vol. 12, No. 3, 175-181 (2007)
DOI: 10.1177/1358863X07081139
© 2007 SAGE Publications

Should troponin and creatinine kinase be routinely measured after vascular surgery?

Emile R. Mohler, III

University of Pennsylvania School of Medicine, Philadelphia, PA, USA, mohlere{at}uphs.upenn.edu

Srinivas Mantha

Nizam's Institute of Medical Sciences, Hyderabad, India

Alan B. Miller

University of Florida, Jacksonville, FL, USA

Don Poldermans

Erasmus Medical Centre, Rotterdam, The Netherlands

Anne B. Cropp

Pfizer Inc., New London, CT, USA

Lisa B. St. Aubin

Pfizer Inc., New London, CT, USA

Clare B. Billing, JR

Pfizer Inc., New London, CT, USA

Lee A. Fleisher

University of Pennsylvania School of Medicine, Philadelphia, PA, USA

The current guidelines for the evaluation and prediction of adverse cardiovascular events (CVEs) following vascular surgery in high-risk patients recommends serial electrocardiograms (ECGs) but not biomarkers such as cTn-I and CK-MB. The objective of this study was to determine whether biomarkers should be routinely measured in high-risk patients undergoing vascular surgery. A multicenter, prospective study with investigators blinded to core laboratory results was conducted. cTn-I and CK-MB were obtained on the day of surgery, as well as 24 hours, 72 hours and 120 hours after surgery, 24 hours prior to planned hospital discharge and at the onset of symptoms of a suspected CVE. The CVE was adjudicated by an endpoint committee using ECG, biomarker and symptoms data and was defined as cardiac death or myocardial infarction (MI) occurring up to 30 days after surgery. A total of 784 patients, with a mean age of 70.1 (SD ± 9.8), underwent vascular surgery. Of the 83 patients with a CVE, cTn-I was positive in 42 and CK-MB was positive in 29 on or before the day of the CVE. The number of patients not classified as having a CVE but positive for elevation of cTn-I or CK-MB was 64 and 20, respectively. cTn-I was more sensitive than CK-MB (50.6% versus 34.9%) for predicting a CVE. The optimum time for measuring cTn-I after surgery with the highest positive predictive value was 24 hours. In conclusion, these data support routine serial measurement of cTn-I after vascular surgery.

Key Words: creatine kinase • myocardial infarction • troponin


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T. S. Perlstein and J. A. Beckman
Peri-operative cardiac biomarker surveillance: a strategy in need of a goal
Vascular Medicine, August 1, 2007; 12(3): 211 - 213.
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