Perioperative myocardial infarction: a diagnostic dilemma.
Patients undergoing coronary bypass grafting were studied for incidence of perioperative myocardial infarction (MI) using three modalities: serial electrocardiograms (ECG), serial creatine phosphokinase isoenzymes (MB-CPK), and serial technetium 99m-labeled pyrophosphate scans. A definite perioperative MI was diagnosed if the results were positive in two of the three variables studied. The perioperative infarction rate for the entire group was 8%. The operative mortality was 2.9%. Seven of 8 perioperative MIs were diagnosed by the use of scanning alone. The combination of isoenzyme and ECG analysis diagnosed 5 of 8 perioperative MIs. The MB-CPK and ECG studies were associated with a higher incidence of false-positive diagnoses than myocardial scanning. Patients with perioperative MI had a benign clinical course. Justification for performing three routine 99mTc-pyrophosphate scans on all patients undergoing aortocoronary bypass operation is still to be determined.
D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood; D011756:Diphosphates; D004562:Electrocardiography; D005163:Factor Analysis, Statistical; D005189:False Positive Reactions; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007527:Isoenzymes; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000201:enzymology; D011877:Radionuclide Imaging; D013667:Technetium
D011756:Diphosphates; D007527:Isoenzymes; D013667:Technetium; D003402:Creatine Kinase