Significant elevation of biomarkers of myocardial necrosis after coronary artery bypass grafting without myocardial infarction established assessed by cardiac magnetic resonance.
The release of myocardial necrosis biomarkers after off-pump coronary artery bypass grafting (OPCAB) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedure-related myocardial infarction (MI) (type 5) has been controversial. This study aimed to evaluate the amount and pattern of cardiac biomarker release after elective OPCAB in patients without evidence of a new MI on cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE).Patients with normal baseline cardiac biomarkers referred for elective OPCAB were prospectively included. CMR with LGE was performed in all patients before and after interventions. Measurements of troponin I (cTnI) and creatine kinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with new LGE on the postprocedure CMR were excluded.All of the 53 patients without CMR evidence of a procedure-related MI after OPCAB exhibited a cTnI elevation peak above the 99th percentile. In 48 (91%), the peak value was >10 times this threshold. However, 41 (77%) had a CK-MB peak above the limit of the 99th percentile, and this peak was >10 times the 99th percentile in only 7 patients (13%). The median peak release of cTnI was 0.290 (0.8-3.7) ng/mL, which is 50-fold higher than the 99th percentile.In contrast with CK-MB, considerable cTnI release often occurs after an elective OPCAB procedure, despite the absence of new LGE on CMR.
Department of Atherosclerosis, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil.
Leandro Menezes Alves
LMA
da Costa
Whady
W
Hueb
Cesar Higa
CH
Nomura
Alexandre Ciappina
AC
Hueb
Alexandre Volney
AV
Villa
Fernando Teiichi Costa
FTC
Oikawa
Rodrigo Morel
RM
Vieira de Melo
Paulo Cury
PC
Rezende
Carlos Alexandre Wainrober
CAW
Segre
Cibele Larrosa
CL
Garzillo
Eduardo Gomes
EG
Lima
Jose Antonio Franchini
JAF
Ramires
Roberto
R
Kalil Filho
D000368:Aged; D015415:Biomarkers; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form