Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting.
OBJECTIVE
To establish the influence of perioperative myocardial injury on short- and long-term survival after coronary artery bypass grafting (CABG).


RESULTS
The correlation of postoperative serum aspartate aminotransferase and creatine kinase MB to early cardiac-related death and to late survival was evaluated in 4911 patients who underwent CABG consecutively during a 6-year period. There were 93 early deaths (1.9%), 73 of them cardiac-related (1.5% of 4911). After a mean follow-up of 5 years, 409 additional deaths (8.5% of 4818) had occurred. Elevated enzyme levels on day 1 postoperatively highly increased the risk of early cardiac death (serum aspartate aminotransferase >or=2.35 microkat.l(-1): odds ratio 9.2; serum creatine kinase MB >or=61 microg.l(-1): odds ratio 6.0), and increased the risk of late death by approximately 50% (serum aspartate aminotransferase >or=2.35 microkat.l(-1): relative hazard 1.5; serum creatine kinase MB >or=61 microg.l(-1): relative hazard 1.4). This increased risk of death was independent of other risk factors and remained constant over time.


CONCLUSIONS
Enzyme elevation after CABG implied an increased risk of both early and late death. The long-term effect persisted many years after surgery.
Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden.
J
J
Steuer
L-G
LG
Hörte
B
B
Lindahl
E
E
Ståhle
D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality*; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000201:enzymology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011183:Postoperative Complications / Q000097:blood / Q000201:enzymology / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D003402:Creatine Kinase