Perioperative Myocardial Injury and Hemostasis in Patients Undergoing Endovascular Aneurysm Repair for Asymptomatic Infrarenal Abdominal Aortic Aneurysm

Objective: ( I) To report the incidence of myocardial injury in patients undergoing endovascular aortic aneurysm repair (EVAR) through the routine measurement of perioperative cardiac troponin-T (cTnT) and (2) to investigate and correlate changes in perioperative cTnT levels with any concomitant hemostatic derangement. Methods: Prospective study of 30 patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm. Cardiac TnT was assayed at 24 hours postoperatively. Plasma thrombin antithronnbin III complex (TAT), plasminogen activator inhibitor I (PAI-I), tissue plasminogen activator (t-PA) activity, and soluble P-selectin (sP-selectin) were assayed preoperatively and at 24 hours postoperatively. Results: Five (17%) patients demonstrated elevated cTnT levels at 24 hours; 3 patients had no clinical evidence of myocardial injury. There was a positive correlation between cTnT and TAT levels at 24 hours post-EVAR (r = .38, P = .039, Kendall-tau B = 0.26). Conclusions: Endovascular aortic aneurysm repair is associated with a significant risk of perioperative myocardial injury that is underdetected clinically and associated with a procoagulopathic state.