PMID- 31075460 OWN - NLM STAT- MEDLINE DCOM- 20191223 LR - 20191223 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 60 DP - 2019 Oct TI - Surveillance and Management of Troponin Elevation after Vascular Surgery. PG - 156-164 LID - S0890-5096(19)30280-8 [pii] LID - 10.1016/j.avsg.2019.02.025 [doi] AB - BACKGROUND: Postopertive troponin elevation may occur without typical or atypical cardiac symptoms and is associated with an increased 30-day morbidity and mortality. The objective of the study was to implement a quality improvement initiative of postoperative troponin surveillance algorithm aimed at intensifying medical management after vascular surgery. METHODS: We conducted a single-center study of postoperative troponin surveillance after vascular surgery (n = 201) at a tertiary care, academic medical center from January to December 2016. Troponin surveillance was performed on postoperative days 1-3 after carotid endarterectomy, endovascular aortic repair, infrainguinal bypass, open abdominal aortic aneurysm repair, peripheral vascular intervention, and suprainguinal bypass, regardless of cardiac symptoms. Patients with troponin I elevation (>0.034 ng/mL) were managed with a treatment algorithm which included single or dual antiplatelet (AP) agent, high-intensity statin therapy, smoking cessation consultation, and outpatient cardiology consultation and stress testing. Patients with troponin elevation >/=1.0 ng/mL received inpatient cardiology consultation. We assessed adherence to the protocol for intensification of best medical therapy defined as high-dose statin therapy, increase in AP therapy, and smoking cessation consultation according to the established algorithm. RESULTS: Troponin elevation was recorded in 17% (34/201) of patients and was associated with cardiac symptoms in 8 patients (24%), while 26 (76%) patients had an asymptomatic abnormal troponin on postoperative surveillance. One patient was excluded due to death immediately after SUPRA, resulting in 200 patients. Troponin elevation >/=1.0 ng/mL occurred in 11 asymptomatic patients (5.5%). Any intensification of medical therapy was instituted in 76% of patients with elevated troponin and included high-intensity statin therapy (58%), increase in AP therapy (18%), and smoking cessation consultation (66%). Once an elevated troponin level was recognized, 52% of our patients received cardiology consultation with an increased likelihood (100%) in patients with troponin >/=1 ng/mL (P < 0.001). Adherence to outpatient stress testing was 66%. Intensification of medical therapy was not significantly different between patients with abnormal troponin values, >0.034-1.0 (n = 23) versus >/=1.0 ng/mL (n = 10); statin therapy (P = 1.0), AP (P = 0.34), and smoking cessation (P = 1.0). One-year mortality was higher in patients with postoperative troponin elevation than those with normal postoperative troponin levels (12% vs. 2.4%; P = 0.03). CONCLUSIONS: Routine postoperative troponin surveillance results in intensification of statin therapy in patients with asymptomatic troponin elevation. Further study is needed to determine if this approach reduces long-term cardiovascular morbidity and mortality. CI - Published by Elsevier Inc. FAU - Shukla, Mrinal AU - Shukla M AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. FAU - Callas, Peter W AU - Callas PW AD - Division of Epidemiology, Department of Mathematics and Statistics, The University of Vermont College of Medicine, University of Vermont, Burlington, VT. FAU - Lahiri, Julie A AU - Lahiri JA AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. FAU - Alef, Matthew J AU - Alef MJ AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. FAU - Keating, Friederike K AU - Keating FK AD - Division of Cardiology, Department of Internal Medicine, The University of Vermont Medical Center, Burlington, VT. FAU - Stanley, Andrew C AU - Stanley AC AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. FAU - Steinthorsson, Georg AU - Steinthorsson G AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. FAU - Schneider, David J AU - Schneider DJ AD - Division of Cardiology, Department of Internal Medicine, The University of Vermont Medical Center, Burlington, VT. FAU - Bertges, Daniel J AU - Bertges DJ AD - Division of Vascular Surgery, Department of Surgery, The University of Vermont Medical Center, Burlington, VT. Electronic address: daniel.bertges@vtmednet.org. LA - eng PT - Journal Article DEP - 20190508 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 RN - 0 (Biomarkers) RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Platelet Aggregation Inhibitors) RN - 0 (Troponin) SB - IM MH - Aged MH - Aged, 80 and over MH - Biomarkers/blood MH - Female MH - Heart Diseases/blood/*diagnosis/etiology/therapy MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use MH - Male MH - Middle Aged MH - Platelet Aggregation Inhibitors/therapeutic use MH - Predictive Value of Tests MH - Prospective Studies MH - *Quality Improvement MH - *Quality Indicators, Health Care MH - Risk Factors MH - Smoking Cessation MH - Time Factors MH - Treatment Outcome MH - Troponin/*blood MH - Up-Regulation MH - Vascular Surgical Procedures/*adverse effects EDAT- 2019/05/11 06:00 MHDA- 2019/12/24 06:00 CRDT- 2019/05/11 06:00 PHST- 2018/08/21 00:00 [received] PHST- 2019/01/11 00:00 [revised] PHST- 2019/02/11 00:00 [accepted] PHST- 2019/05/11 06:00 [pubmed] PHST- 2019/12/24 06:00 [medline] PHST- 2019/05/11 06:00 [entrez] AID - S0890-5096(19)30280-8 [pii] AID - 10.1016/j.avsg.2019.02.025 [doi] PST - ppublish SO - Ann Vasc Surg. 2019 Oct;60:156-164. doi: 10.1016/j.avsg.2019.02.025. Epub 2019 May 8.