Myocardial injury and bypass grafting. Value of serum enzymes in diagnosis.
To clarify the value of serum enzymes in the detection of intraoperative and postoperative myocardial injury associated with coronary artery bypass grafting, we evaluated 70 consecutive patients (151 grafts). We used electrocardiograms and serial determinations of serum levels: serum glutamic oxaloacetic transaminase (SGOT), creatinine phosphokinase (CPK), lactic dehydrogenase (LDH), and LDH isoenzymes on Days zero, 1, 3, 5, 7, and 10. Patency of all grafts 1 week postoperatively was 92 per cent. Fourteen patients (20 per cent) had ECG evidence of acute myocardial infarction (AMI) or ischemia lasting longer than 48 hours. This incidence of AMI was attendant with no deaths or discernible changes in postoperative ventriculography. LDH-1 (cardiac fraction) was elevated in all patients with myocardial injury. Late elevation of LDH-1 occurred in 2 patients at the time of postoperative catheterization, 1 of whom had negative findings on ECG. Diagnostic correlation was not observed with total LDH, CPK, or SGOT. Predisposing factors to AMI included preinfarction angina (4 of 14 patients), occluded grafts (4 of 14), and a bypass time greater than 120 minutes.
D000787:Angina Pectoris / Q000601:surgery*; D000790:Angiocardiography; D001219:Aspartate Aminotransferases / Q000097:blood*; D001281:Atrial Fibrillation / Q000209:etiology; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood*; D005069:Evaluation Studies as Topic; D006801:Humans; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000201:enzymology*; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000201:enzymology; D014182:Transplantation, Autologous; D014680:Veins / Q000637:transplantation
D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D003402:Creatine Kinase