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The Journal of Cardiovascular Surgery 2020 Sep 04

DOI: 10.23736/S0021-9509.20.11205-9


lingua: Inglese

Myocardial injury after non-cardiac surgery (MINS) in EVAR patients: a retrospective single-centre study

Joel SOUSA 1, 2 , João ROCHA-NEVES 1, 2, José OLIVEIRA-PINTO 1, 2, Armando MANSILHA 1, 2

1 Department of Angiology and Vascular Surgery, Centro Hospitalar de S.João, Porto, Portugal; 2 Department of Physiology and Surgery, Faculty of Medicine of the University of Porto, Porto, Portugal


BACKGROUND: MINS (myocardial injury after non-cardiac surgery) stands for myocardial injury due to ischemia that occurs during or within 30-days after non-cardiac surgery. Although MINS is known to be independently associated with 30-day mortality after intervention, little is described about the impact of MINS after vascular procedures, particularly after endovascular aneurysm repair (EVAR).
METHODS: Observational, retrospective, single-centre study. All patients undergoing elective standard EVAR between January 2008 and June 2017, and with at least one post-operative measurement of troponin I in the first 48h after surgery, were retrospectively included. MINS was defined as the value exceeding the 99th percentile of a normal reference population with a coefficient of variation<10%. Primary outcomes include the prevalence of MINS in this subset of EVAR patients, as well as its impact in mid-term all-cause mortality. As secondary aim, the preoperative predictors of MINS were also assessed.
RESULTS: One-hundred and thirty six patients with post-operative troponin measurements were included (95.6% male; mean age 75.51years). MINS was diagnosed in 16.2% (n=22) of the patients, and in 86.4% of the cases (n=19) it was completely asymptomatic. Heart failure (31.8% vs 10.5%, P=0.016), ASA score >3 (95.5% vs 67.5%, P=0.004) and pre-operative (P=0.036) and post-operative (P=0.04) hemoglobin concentrations < 12 g/dl were found to be significantly associated with MINS. Regarding remaining baseline characteristics, anesthesia and femoral access, no further differences were observed. Survival at 1, 3 and 5 years was 92% (95% CI 4.6-6.9, standard error (SE) 0.023), 81% (95% CI 5.6-7.6, SE 0.034) and 71% (95% CI 6.9-8.7, SE 0.04), with two deaths reported at 30 days follow-up. MINS was found to be significantly associated with increased mid-term all-cause mortality after EVAR at 24 months follow-up (84.2% ± 3.4% vs 63.6% ± 10.3%,P=0.001), with a 2.12-fold risk increase of death.
CONCLUSIONS: MINS is a common complication after EVAR and negatively impacts the mid-term prognosis of such interventions. In the majority of cases it is asymptomatic and therefore not detectable unless routine post-operative troponin measurements are performed.

KEY WORDS: Abdominal aortic aneurysm; Endovascular aneurysm repair; Myocardial injury after non-cardiac surgery

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