Myocardial Injury After Aortoiliac Surgery for TASC type D Lesions: a Survival Analysis

Abstract

Background: Troponin elevation after vascular surgery (MINS) is a frequent event, ranging between 12 - 20%, even more common after revascularization in patients with peripheral artery disease (PAD). Myocardial injury is strongly associated with higher mortality in short and long-term periods with a ten-fold and two-fold increased risk, respectively. Still, there is lack of data regarding myocardial injury after aorto-iliac TASC-D revascularization and this study aims to evatuate the prognostic impact of MINS and its perioperative determinants. Material and methods: From a tertiary referral hospital, patients with TASC-D lesions were consecutively retrieved from a prospective database. Study population was submitted to revascularization either by open surgery or percutaneous artery stenting according to the surgeons' discretion. Cardiac troponins were routinely measured in the postoperative period. Myocardial infarction (MI), acute heart failure (AHF), stroke, major adverse cardiovascular events (MACE), major adverse limb events (MALE) and all-cause mortality were assessed both post-operativelly and at follow-up. Results: The incidence of MINS was 25.8%. Multivariate analysis has confirmed chronic heart failure as a significant risk-factor for MINS with Hazard ratio (HR) = 21.3 (95% Confidence interval (CI) 1.696 - 268.0, P = 0.018). At 12 months after revascularization, troponin elevation was found to be significantly associated with further MI, stroke, AHF, MALE, MACE and all-cause death. Conclusion: MINS plays a role as a predictor of significant cardiovascular comorbidities and mortality during follow-up. Moreover, the presence of Chronic heart failure was associated with higher incidence of myocardial lesions after aortoiliac TASC-D revascularization. In light of current evidence, pre-emptive strategies should be adopted to detect and treat these patients together with the opportunity to initiate secondary prophylactic measures and surveillance.