Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery.
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.
Thielmann
Matthias
M
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
Massoudy
Parwis
P
Schmermund
Axel
A
Neuhäuser
Markus
M
Marggraf
Günter
G
Kamler
Markus
M
Herold
Ulf
U
Aleksic
Ivan
I
Mann
Klaus
K
Haude
Michael
M
Heusch
Gerd
G
Erbel
Raimund
R
Jakob
Heinz
H
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*
D015415:Biomarkers; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form