Abstract 265: Perioperative Silent Myocardial Ischemia, the Use of Blood Transfusions and Their Associations With Long-Term Mortality Following Peripheral Vascular Surgery
Objective Thrombotic and bleeding complications during the perioperative period are a major concern during the postoperative period. However, the relationship between perioperative myocardial necrosis and major bleeding with long-term mortality is uncertain.
Methods In a retrospective study, we analyzed data from 289 consecutive patients during a one-year period between 2009-2010 who underwent open major vascular surgery (carotid endarterectomy, above/below knee amputation, open aneurysm repair, extremity bypass, and embolectomy). Myocardial necrosis was defined as any cardiac troponin T value ≥ 0.1 ng/ml and major bleeding was defined as requiring ≥2 units of blood within 24 hours of the operation. Lower threshold cutoffs (troponin >0.04 ng/ml and any transfusion) were also investigated. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression.
Results During a mean follow-up period of 1.8 years, there were 46 deaths (15.9%). Myocardial necrosis and major bleeding occurred in 25.2% and 14.9% of subjects, respectively. After adjustment for age, sex, smoking, hypertension, diabetes and coronary artery disease, both myocardial necrosis (OR 4.24, 95% CI 1.82-9.87) and major bleeding (OR 2.56, 95% CI 1.28-5.46) were associated with long-term death. Similarly, lower threshold cutoffs of troponin >0.04 ng/ml and any transfusion independently predicted a 6.27-fold and a 6.44-fold increase in long-term mortality (p<0.001 for both).
Conclusions Perioperative myocardial necrosis and major bleeding, even at low cutoff levels, are independent and complementary predictors of long-term mortality following major vascular surgery.
- © 2013 by American Heart Association, Inc.