Subclinical perioperative Myocardial Injury following Complex Endovascular Aortic Repair is associated with increased mid-term mortality; a retrospective study

Perioperative myocardial injury (PMI), defined by an asymptomatic increase in troponin levels, has been recognized as prognostic marker for impaired survival following non-cardiac surgery with therapy for improvement potentially available. Patients undergoing complex endovascular aneurysm repair (c-EVAR) may be particularly at risk for PMI due to their cardiovascular burden. However, due to lacking routine perioperative troponin monitoring, the incidence and impact of PMI on long term mortality following c-EVAR remains unclear with no possibility of applying improvement strategies.

Methods

Preoperative and consecutive postoperative high-sensitivity troponin-T (hsTnT) levels were retrospectively analysed from all patients who underwent elective c-EVAR in a Dutch tertiary hospital between 2012 and 2022. PMI was defined as a difference between pre- to postoperative troponin concentrations (ΔhsTnT) of more than ≥14 ng/L in the absence of clinical features of myocardial infarction. Primary objectives were the incidence of PMI following c-EVAR and its association with four-year mortality.

Results

180 patients were included. Median follow-up time was 41 months. 38 patients (21.1%) developed PMI. Coronary artery disease was more prevalent (CAD)(68.4 % vs. 42.3%, p=.012) and ASA-scores were higher in patients with PMI (ASA-4: 13.1% vs. 7.8%, p=.044). PMI was independently associated with increased four-year mortality (adjusted HR: 2.37 (95% CI: 1.25-4.48), p=.008). CAD (adjusted OR: 2.38 (95% CI: 1.07-5.51), p=.037) and preoperative elevated troponin levels (adjusted HR: 2.65 (95% CI: 1.19-6.3, p=.023) were independently associated with an increased risk for PMI.

Conclusion

Asymptomatic PMI is relatively common following c-EVAR and is associated with impaired mid-term survival. Given the high prevalence of cardiovascular comorbidities in patients with PMI, prospective follow-up studies should focus on the potential of routine perioperative hsTnT monitoring in identifying high-risk patients who could potentially benefit from enhanced cardiac care.