Editor's Choice - TROPonin In CArotid Revascularisation - TROPICAR: Preliminary 30 Day Results

Abstract

Objective: To assess the prevalence and risk factors for the development of myocardial injury (MIn) in patients undergoing carotid revascularisation and to assess whether elevated troponin levels can predict the occurrence of adverse cardiac events and short term death.

Methods: This prospective, multicentre cohort study included 527 patients subjected to carotid revascularisation from June to October 2023. High sensitive cardiac troponin I and or T were assessed pre-operatively, and eight and 24 hours post-operatively. Myocardial injury was defined as at least one value of cardiac troponin above the 99th percentile upper reference limit.

Results: Four hundred and forty patients (83.5%) underwent carotid endarterectomy and 87 (16.5%) carotid artery stenting (85 under local infiltrative and two under general anaesthesia). Of the 527 patients, 87 (16.5%) were operated under general, 355 (67.4%) under regional anaesthesia, and the remaining 85 (16.1%) received local anaesthetic infiltration. Pre-operatively, MIn was noted in 7% of patients, and the overall prevalence of post-operative MIn was 12.3%. Age ≥ 81 years, pre-operative haemoglobin 10 - 13.9 g/dL and glomerular filtration rate 15 - 30 mL/min/1.73 m² were independent predictors of post-operative MIn (OR 2.84, 95% CI 1.17 - 6.91, p = .021; OR 1.95, 95% CI 1.01 - 3.76, p = .046; OR 11.46, 95% CI 2.37 - 55.33, p = .002, respectively). Myocardial infarction (MI) developed in seven patients (1.3%), more frequently in those who had MIn eight and 24 hours following surgery (71.4% vs. 10.4%, p = .001; 71.4% vs. 10.2%, p = .001, respectively).

Conclusion: Myocardial injury is common in patients undergoing carotid revascularisation; to reduce the rate of MIn, special attention should be paid to those patients with risk factors identified in the present study. Long term (one and two year) follow up of the TROPICAR patients will provide additional insights into the association between peri-operative MIn, MI, and death.

Keywords: Carotid stenosis; High sensitive cardiac troponin; Myocardial infarction; Peri-operative myocardial injury.