Document Detail

Peri-operative myocardial injury in patients undergoing surgery for critical limb ischaemia.
MedLine Citation:
PMID:  15694805     Owner:  NLM     Status:  MEDLINE    
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.
S D Hobbs; M Yapanis; P J Burns; A B Wilmink; A W Bradbury; D J Adam
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Publication Detail:
Type:  Journal Article    
Journal Detail:
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:
Created Date:  2005-02-07     Completed Date:  2005-04-14     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  301-4     Citation Subset:  IM    
University Department of Vascular Surgery, Birmingham Heartlands Hospital, Birmingham, UK.
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MeSH Terms
Aged, 80 and over
Blood Vessel Prosthesis Implantation / adverse effects*
Creatine Kinase / blood
Creatine Kinase, MB Form
Intraoperative Complications / diagnosis*
Ischemia / surgery*
Isoenzymes / blood
Lower Extremity / blood supply*
Middle Aged
Myocardial Infarction / blood,  diagnosis*,  etiology
Postoperative Complications / diagnosis*
Prospective Studies
Treatment Outcome
Troponin I / blood
Reg. No./Substance:
0/Isoenzymes; 0/Troponin I; EC Kinase; EC Kinase, MB Form
Comment In:
Eur J Vasc Endovasc Surg. 2005 Sep;30(3):332-3; author reply 333-4   [PMID:  15967689 ]

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