title: Biochemical markers of perioperative myocardial ischemia in patients with coronary artery bypass grafting.
abstract: Aims of the study: The evaluation of significant perioperative ischemic processes after coronary artery bypass grafting from postoperative ECG, creatine kinase (CK) and CK iso-enzyme MB remains unreliable and, hence, insufficient. Additional, early available biochemical markers could improve the diagnostics of ischemia. Methods: In 86 patients with multiple vessel disease, activity of serum CK and CK-MB as well as mass of CK-MB, myoglobin and troponin-T were analyzed before and after surgery. Twelve-lead electrocardiograms were evaluated before surgery, 3h postoperatively, and before discharge from hospital. Results: In patients with signs of perioperative ischemia in the 3-hour ECG, primary postoperative peak values of myoglobin and CK were distinctly higher than in patients without signs of ischemia, with median values of 1437 ng/ml vs. 986 ng/ml for myoglobin and of 632 U/l vs. 481 U/l (n.s.) for CK. Sensitivity and specificity of myoglobin were 64 % and 69 %, followed by CK with 61 % and 62 %, respectively. Conclusions: Myoglobin, indicating the risk of perioperative ischemia approximately 45 minutes after declamping of the aorta, is suggested as a candidate for early available routine monitoring.
authors.affiliation: Department of Cardio-Thoracic Surgery,University of Vienna, Vienna,1090, Austria. Friederike.Neumann@akh-wien.ac.at
authors.initials: F
authors.lastname: Neumann
authors.initials: A
authors.lastname: Griesmacher
authors.initials: W
authors.lastname: Mohl
authors.initials: B
authors.lastname: Zweytick
authors.initials: N
authors.lastname: Kupilik
authors.initials: G
authors.lastname: Stix
authors.initials: MM
authors.lastname: Mueller