One Year Follow Up of the TROPonin In CArotid Revascularisation (TROPICAR) Study.

OBJECTIVE

The aim of this study was to examine the association between peri-operative myocardial injury (MIn) and the occurrence of adverse cardiovascular events and or death one year after carotid revascularisation.

METHODS

In this prospective, multicentre cohort study, 527 consecutive patients undergoing elective carotid endarterectomy (CEA) or carotid artery stenting (CAS) (June - October 2023) were enrolled across five tertiary centres. High sensitivity cardiac troponin was measured pre- and post-operatively, and patients were followed for one year. The primary endpoint was myocardial infarction (MI). Secondary endpoints were stroke, cardiac related death, and all cause death one year following CEA or CAS. Survival analysis was used to assess the impact of MIn on time dependent outcomes of interest.

RESULTS

One year follow up was completed in 505 patients (95.8%), predominantly men (n = 349, 69.1%), asymptomatic (n = 339/504, 67.3%), with a mean age of 71.6 ± 8.6 years (range 41 - 90 years). During follow up, eight lethal outcomes were documented, of which one patient (0.2%) died due to cardiac related cause. One year post-operatively, the incidence of MI was 2.6% (n = 13) and the incidence of stroke was 3.8% (n = 19). Post-operative MIn and pre-operative diagnosis of malignancy independently predicted MI within one year after CEA or CAS (odds ratio [OR] 6.54, 95% confidence interval [CI] 1.91 - 22.22, p = .003; OR 6.13, 95% CI 1.67 - 22.73, p = .006, respectively). MI free survival was statistically significantly lower in patients with post-operative MIn one year after CEA or CAS (91.9% vs. 98.2%, log rank p = .003).

CONCLUSION

Post-operative MIn independently predicted one year MI following CEA or CAS. Patients with post-operative MIn after carotid revascularisation represent a high risk subgroup in whom targeted strategies should be considered in order to reduce the risk of subsequent cardiac adverse events.