title: Association between CK-MB Area Under the Curve and Tranexamic Acid Utilization in Patients Undergoing Coronary Artery Bypass Surgery.
abstract: Myonecrosis after coronary artery bypass graft (CABG) surgery is associated with excess mortality. Tranexamic acid (TA), an anti-fibrinolytic agent, has been shown to reduce peri-operative blood loss without increasing the risk of myocardial infarction (MI); however, no large study has examined the association between TA treatment and post-CABG myonecrosis. In the MC-1 to Eliminate Necrosis and Damage in Coronary Artery Bypass Graft Surgery II trial, inverse probability weighting of the propensity to receive TA was used to test for differences among the 656 patients receiving and 770 patients not receiving TA. The primary outcome was creatine kinase MB (CK-MB) area under the curve (AUC) through 24 h. The secondary outcome was 30-day cardiovascular death or MI. Patients who received TA were more frequently female, had a previous MI, heart failure, low molecular weight heparin therapy, on-pump CABG, valvular surgery, and saphenous vein or radial grafts. The median 24-h CK-MB AUC was higher in TA-treated patients [301.9 (IQR 196.7-495.6) vs 253.5 (153.4-432.5) ng h/mL, p < 0.001]. No differences in the 30-day incidence of cardiovascular death or MI were observed (8.7 vs 8.3%, adjusted OR 0.99; 95% CI 0.67-1.45, p = 0.948). In patients undergoing CABG, TA use was associated with a higher risk of myonecrosis; however, no differences were observed in death or MI. Future larger studies should be directed at examining the pathophysiology of TA myonecrosis, and its association with subsequent clinical outcomes.
authors.affiliation: Department of Critical Care and Division of Cardiology, 2C2 Cardiology Walter MacKenzie Center, University of Alberta Hospital, 8440 112th St., Edmonton, AB, T6G 2B7, Canada. sv9@ualberta.ca.
authors.forename: Sean
authors.initials: S
authors.lastname: van Diepen
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Merrill
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.|Divisions of Cardiothoracic Anesthesia and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Mihai
authors.initials: M
authors.lastname: Podgoreanu
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Renato D
authors.initials: RD
authors.lastname: Lopes
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents; D019540:Area Under Curve; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000032:analysis*; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009203:Myocardial Infarction / Q000209:etiology; D009336:Necrosis; D014148:Tranexamic Acid / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D052279:Creatine Kinase, MB Form
keywords: CABG; CK-MB; Myonecrosis; Tranexamic acid