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 1 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 1 year. The primary endpoint was myocardial infarction (MI). Secondary endpoints were stroke, cardiac related death, and all cause death 1 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 males (n = 349, 69.1%), asymptomatic (n = 339, 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 1 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 1 year after CEA or CAS (91.9% vs. 98.2%, log rank p = .003). Conclusion: Post-operative MIn independently predicted 1 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 to reduce the risk of subsequent cardiac adverse events.