| Peri-operative myocardial injury in patients undergoing surgery for critical limb ischaemia. | |
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MedLine Citation:
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PMID: 15694805 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Although up to a half of patients undergoing abdominal aortic aneurysm (AAA) repair suffer myocardial injury, as indicated by a rise in cardiac troponin I (cTnI), this is infrequently accompanied by a rise in creatine kinase (CK)-MB fraction or electrocardiogram (ECG) changes. This study compares for the first time peri-operative cTnI, CK-MB and ECG changes in patients undergoing surgery for critical lower limb ischaemia (CLI). METHODS: Twenty-nine patients (20 men, median age 75 [range, 57-95] years) were studied prospectively. cTnI, CK/CK-MB ratio and ECG were performed pre-operatively and on post-operative days 1, 2 and 3. RESULTS: Eleven (38%) patients had an elevated cTnI >0.5 ng/ml. Five (17%) patients had an elevated CK-MB fraction >4% and all of these patients had an elevated cTnI. Eleven (38%) patients had ischaemic changes on ECG including seven of 11 (64%) patients with elevated cTnI and all five patients with elevated CK-MB fraction. There was no relationship between pre-operative cardiac status, antiplatelet use or type of anaesthesia and post-operative cTnI rise. Patients with a cTnI rise were younger (p=0.01), and were more likely to have presented with gangrene (p=0.04) and have a longer operation time (p=0.01) than patients who did not demonstrate a cTnI rise. Four patients developed clinically apparent cardiac complications: cardio-pulmonary arrest (n=1), cardiogenic shock (n=1), acute CCF (n=1) and rapid atrial fibrillation (n=1). Survival at 6 months was 26 of 29 (90%) patients. CONCLUSION: These data demonstrate that over a third of patients operated for CLI sustain peri-operative myocardial injury, many of which are not clinically apparent. Pre-operative medical optimisation may improve prognosis in this group of patients. |
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Authors:
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S D Hobbs; M Yapanis; P J Burns; A B Wilmink; A W Bradbury; D J Adam |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Volume: 29 ISSN: 1078-5884 ISO Abbreviation: Eur J Vasc Endovasc Surg Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-02-07 Completed Date: 2005-04-14 Revised Date: 2005-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9512728 Medline TA: Eur J Vasc Endovasc Surg Country: England |
Other Details:
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Languages: eng Pagination: 301-4 Citation Subset: IM |
Affiliation:
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University Department of Vascular Surgery, Birmingham Heartlands Hospital, Birmingham, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Blood Vessel Prosthesis Implantation / adverse effects* Creatine Kinase / blood Creatine Kinase, MB Form Electrocardiography Female Humans Intraoperative Complications / diagnosis* Ischemia / surgery* Isoenzymes / blood Lower Extremity / blood supply* Male Middle Aged Myocardial Infarction / blood, diagnosis*, etiology Postoperative Complications / diagnosis* Prospective Studies Treatment Outcome Troponin I / blood |
| Chemical | |
Reg. No./Substance:
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0/Isoenzymes; 0/Troponin I; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form |
| Comments/Corrections | |
Comment In:
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Eur J Vasc Endovasc Surg. 2005 Sep;30(3):332-3; author reply 333-4
[PMID:
15967689
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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