title: Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery.
abstract: OBJECTIVE
  The rise of markers for myocardial injury indicates early graft-related or non-graft-related perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG). A diagnostic discrimination between these two situations may enable adequate therapeutic measures, limiting myocardial damage, and improving outcome.
  
  
  RESULTS
  In a prospective study, 94 among 3308 consecutive CABG patients underwent acute reangiography because of evidence of PMI. Of these 94 patients, 56 had graft-related PMI (group 1), 38 patients had non-graft-related PMI (group 2), and 95 patients without evidence of PMI and angiographically patent grafts served as control (group 3). Cardiac troponin I (cTnI), creatine kinase (CK), and its MB fraction were determined. CTnI, but not CK/CK-MB levels were significantly higher in group 1 than in groups 2 and 3 at 12 and 24 h after aortic unclamping (P<0.0001). Receiver operating characteristic and multivariable logistic regression analyses indicated cTnI as the best discriminator between PMI 'in general' and 'inherent' release of cTnI after CABG with a cut-off value of 10.5 ng/mL and between graft-related and non-graft-related PMI with a cut-off value of 35.5 ng/mL.
  
  
  CONCLUSIONS
  Perioperative cTnI elevation after CABG separates among patients with graft-related, non-graft-related, and without PMI, however, not earlier than 12 h after surgery.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. matthias.thielmann@uni-essen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Parwis
authors.initials: P
authors.lastname: Massoudy
authors.forename: Axel
authors.initials: A
authors.lastname: Schmermund
authors.forename: Markus
authors.initials: M
authors.lastname: Neuhäuser
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
authors.forename: Ulf
authors.initials: U
authors.lastname: Herold
authors.forename: Ivan
authors.initials: I
authors.lastname: Aleksic
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D011182:Postoperative Care / Q000379:methods; D012372:ROC Curve; D019233:Retreatment; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form