Postoperative levels of cardiac troponin versus CK-MB and high-sensitivity C-reactive protein for the prediction of 1-year cardiovascular outcome in patients undergoing vascular surgery George N. Kouvelos a , Haralampos J. Milionis b , Eleni M. Arnaoutoglou c , George Chasiotis d , Constantina Gartzonika e , Nektario K. Papa a , Petros Tzimas c and Miltiadis I. Matsagkas a Objective This study evaluated comparatively the predictive value of postoperative cardiac troponin I (cTnI), creatinine kinase (CK)-MB, and high-sensitivity C-reactive protein (hs-CRP) in 1-year cardiovascular mortality and morbidity in patients undergoing elective vascular surgery. Methods A total of 295 consecutive patients undergoing elective noncardiac vascular surgery were prospectively followed-up over a period of 12 months. The levels of cTnI, CK-MB, and hs-CRP were measured preoperatively and 24h after operation. The primary endpoint was the composite of cardiovascular death, nonfatal acute myocardial infarction, ischemic stroke, and unstable angina. Results The primary endpoints occurred in 11 patients (3.8%). Receiver operating characteristic curve analysis showed that postoperative cTnI was a strong predictor of a cardiovascular event during 1-year follow-up (area under the curve, 0.852; P < 0.001). Areas under the curve for hs-CRP and for CK-MB were 0.734 (P = 0.008) and 0.494 (P = 0.947). A threshold cTnI value of 0.4 ng/ml was highly associated with the occurrence of a cardiovascular event, with a sensitivity of 80% and specificity of 81%. Furthermore, cTnI levels provided a significantly better prediction than CK-MB levels (P = 0.009) and tended to be superior to hs-CRP (P = 0.2). Conclusion Postoperative cTnI levels seem to be superior to CK-MB and hs-CRP levels for the prediction of 1-year cardiovascular mortality and morbidity in patients undergoing elective vascular surgery. Coron Artery Dis 22:428–434  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Coronary Artery Disease 2011, 22:428–434 Keywords: cardiovascular event, risk prediction, troponin, vascular surgery a Departments of Surgery–Vascular Surgery Unit, b Internal Medicine, c Anesthesiology, d Laboratory of Clinical Chemistry and e Microbiology, School of Medicine, University of Ioannina, Ioannina, Greece Correspondence to Miltiadis I. Matsagkas, MD, PhD, EBSQ-Vasc, Associate Professor of Vascular Surgery, Department of Surgery–Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina University Campus, S. Niarchos Ave., Ioannina 45110, Greece Tel: +30 26 5100 7422; fax: +30 26 5103 3379; e-mail: mimats@cc.uoi.gr; mmats@otenet.gr Received 2 March 2011 Revised 11 April 2011 Accepted 24 April 2011 Introduction Cardiovascular complications comprise a major cause of morbidity and mortality in patients undergoing non- cardiac vascular surgery, affecting both short-term and long-term prognoses. The incidence of perioperative myocardial infarction (MI) in major vascular surgery is 4–5% and the prevalence of symptomatic or asymptomatic perioperative myocardial damage as assessed by serum concentration of troponin I or T ranges from 14 to 47% [1–3]. The long-term outcome of vascular patient after surgery is also implicated by their cardiac condition, as cardiovascular death accounts for up to 50% of long-term mortality [3]. In this setting, early recognition of patients at an increased cardiovascular risk is of utmost importance. There seems to be a constant need for the establishment of markers with sufficient predictive value, especially with regard to mid-term and long-term prognoses. Currently, biochemical markers including troponin, crea- tine kinase-MB (CK-MB) fraction, high-sensitivity C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide, are increasingly used for cardiac risk stratification [4]. These biomarkers estimate different phenomena, including cell death, inflammation, and any myocardial insult, which may reflect different pathophy- siological pathways during the occurrence of major cardio- vascular events. Troponin I consists of a cardiac-specific protein with high sensitivity and specificity for myocar- dial injury [5] that may predict an increased risk of mortality and reinfarction in patients with acute coronary syndrome [6]. If cardiac troponin I (cTnI) release after major vascular surgery is affiliated with poor mid-term outcome, it might be used to identify those patients who will benefit from extensive follow-up and aggressive medical treatment. The aim of this study was to evaluate comparatively the predictive value of postoperative cTnI, CK-MB, and hs- CRP levels for mid-term cardiovascular mortality and morbidity after noncardiac major vascular surgery. 428 Diagnostic methods 0954-6928  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MCA.0b013e3283487d96