title: [Evaluation of postoperative myocardial injury by heart-type fatty acid-binding protein in off-pump coronary artery bypass grafting surgery].
abstract: Postoperative myocardial infarction is a serious and frequent complication of cardiac surgery. Nonetheless, diagnosis in this context it is occasionally challenging. We sought to evaluate the kinetics and diagnostic accuracy of the new biomarker « heart-type fatty acid-binding protein » (h-FABP) in the early detection of myocardial injury in patients undergoing off-pump coronary artery bypass grafting, compared with classical biomarkers.
  
  
  METHODS
  A prospective study was conducted on 17 consecutive patients who underwent off-pump coronary artery bypass grafting during a 2 month period. Blood samples were drawn for measurement of myocardial ischemic injury biomarkers (h-FABP, troponin, creatine kinase [CK] and CK-MB), at baseline (T1), immediate post-coronary artery bypass grafting (T2), on ICU admission (T3), and after 4 (T4), 8 (T5), 24 (T6) and 48 h (T7). Perioperative ischemic complications, defined according to electrocardiographic, echocardiographic and hemodynamic criteria, were recorded.
  
  
  RESULTS
  Earlier biomarkers peak plasma values occurred at T4 with troponin (2.9 ± 5.2 ng/mL), and at T5 with h-FABP (37.9 ± 55.5 ng/mL). Maximum values of CK and CK-MB occurred later, both in T6 (741 ± 779 and 37 ± 51 U/L, respectively). The optimized cut-off obtained for h-FABP was 19 ng/mL, providing a sensitivity and specificity of 77 and 75%, respectively, for diagnosis of perioperative ischemic injury, with an area under the ROC curve for h-FABP of 0.83 (95% CI 0.6-1.0) vs. 0.63 (95% CI 0.33-0.83) for troponin. This cut-off value for h-FABP is reached on average at T2 (mean value of h-FABP at T2: 18.9 ± 21.5 ng/mL).
  
  
  CONCLUSIONS
  This is the first study evaluating the kinetics of h-FABP biomarker in perioperative off-pump coronary artery bypass grafting, and the cut-off value established could help to extend earlier detection of myocardial ischemia in this context.
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: P
authors.initials: P
authors.lastname: Carmona
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España. Electronic address: mateo_eva@gva.es.
authors.forename: E
authors.initials: E
authors.lastname: Mateo
authors.affiliation: Servicio de Análisis Clínicos, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: A
authors.initials: A
authors.lastname: Montoro
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: L
authors.initials: L
authors.lastname: Alós
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: M
authors.initials: M
authors.lastname: Coret
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: C L
authors.initials: CL
authors.lastname: Errando
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: Llagunes
authors.affiliation: Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: J
authors.initials: J
authors.lastname: De Andrés
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood; D015415:Biomarkers; D002303:Cardiac Output, Low / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011446:Prospective Studies; D013997:Time Factors; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D019210:Troponin I; D052279:Creatine Kinase, MB Form
keywords: Biomarcadores; Biomarkers; Cirugía coronaria sin circulacion extracorpórea; Coronary artery bypass surgery without extracorporeal circulation; Heart-fatty acid-binding protein; Infarto de miocardio; Myocardial infarction