title: Accuracy of Myocardial Biomarkers in the Diagnosis of Myocardial Infarction After Revascularization as Assessed by Cardiac Resonance: The Medicine, Angioplasty, Surgery Study V (MASS-V) Trial.
abstract: BACKGROUND
  The lack of a correlation between myocardial necrosis biomarkers and electrocardiographic abnormalities after revascularization procedures has resulted in a change in the myocardial infarction (MI) definition.
  
  
  METHODS
  Patients with stable multivessel disease who underwent percutaneous or surgical revascularization were included. Electrocardiograms and concentrations of high-sensitive cardiac troponin I (cTnI) and creatine kinase (CK)-MB were assessed before and after procedures. Cardiac magnetic resonance and late gadolinium enhancement were performed before and after procedures. MI was defined as more than five times the 99th percentile upper reference limit for cTnI and 10 times for CK-MB in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), respectively, and new late gadolinium enhancement for cardiac magnetic resonance.
  
  
  RESULTS
  Of the 202 patients studied, 69 (34.1%) underwent on-pump CABG, 67 (33.2%) off-pump CABG, and 66 (32.7%) PCI. The receiver operating characteristic curve showed the accuracy of cTnI for on-pump CABG, off-pump CABG, and PCI patients was 21.7%, 28.3%, and 52.4% and for CK-MB was 72.5%, 81.2%, and 90.5%, respectively. The specificity of cTnI was 3.6%, 9.4%, and 42.1% and of CK-MB was 73.2%, 86.8%, and 96.4%, respectively. Sensitivity of cTnI was 100%, 100%, and 100% and of CK-MB was 69.2%, 64.3%, and 44.4%, respectively. The best cutoff of cTnI for on-pump CABG, off-pump CABG, and PCI was 6.5 ng/mL, 4.5 ng/mL, and 4.5 ng/mL (162.5, 112.5, and 112.5 times the 99th percentile upper reference limit) and of CK-MB was 37.5 ng/mL, 22.5 ng/mL, and 11.5 ng/mL (8.5, 5.1, and 2.6 times the 99th percentile upper reference limit), respectively.
  
  
  CONCLUSIONS
  Compared with cardiac magnetic resonance, CK-MB was more accurate than cTnI for diagnosing MI. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI.
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil. Electronic address: whady.hueb@incor.usp.br.
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.affiliation: Mayo Clinic Foundation, Rochester, Minnesota.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Leandro Menezes
authors.initials: LM
authors.lastname: Alves da Costa
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Fernando Teiichi
authors.initials: FT
authors.lastname: Costa Oikawa
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Rodrigo Morel
authors.initials: RM
authors.lastname: Vieira de Melo
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo Cury
authors.initials: PC
authors.lastname: Rezende
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Cibele Larrosa
authors.initials: CL
authors.lastname: Garzillo
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo Gomes
authors.initials: EG
authors.lastname: Lima
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Cesar Higa
authors.initials: CH
authors.lastname: Nomura
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Alexandre Volney
authors.initials: AV
authors.lastname: Villa
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Alexandre Ciappina
authors.initials: AC
authors.lastname: Hueb
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Celia Maria
authors.initials: CM
authors.lastname: Cassaro Strunz
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Desiderio
authors.initials: D
authors.lastname: Favarato
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Myrthes Emy
authors.initials: ME
authors.lastname: Takiuti
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Cicero Piva
authors.initials: CP
authors.lastname: de Albuquerque
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Expedito Eustáquio
authors.initials: EE
authors.lastname: Ribeiro da Silva
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Franchini Ramires
authors.affiliation: Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form