title: Diagnosis of perioperative myocardial infarction after heart valve surgery with new cut-off point of high-sensitivity troponin T and new electrocardiogram or echocardiogram changes.
abstract: Criteria for diagnosing myocardial infarction (MI) after heart valve surgery are not collected in the Third Universal Definition of MI. We aimed to define cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) for the diagnosis of perioperative MI after heart valve surgery according to perioperative MI determined by new alterations in electrocardiogram (ECG) and/or transthoracic echocardiogram (TTE). Secondary endpoints were incidence of perioperative MI, postoperative complications, 30-day mortality, and 2-year survival.
  
  
  
  Heart valve surgery was performed in 805 patients (June 2012-January 2016). hs-cTnT and CK-MB were measured at intensive care unit (ICU) admission and 8, 16, 24, 48, and 72 hours after surgery. Blind to outcomes, we analyzed ECGs and TTEs before and after surgery. Patients were divided into 2 groups: with ECG and/or TTE criteria after surgery (following the consensus statement) and without these changes. We conducted receiver operating characteristic analyses for hs-cTnT and CK-MB in the group with ECG and/or TTE criteria.
  
  
  
  ECG and/or TTE criteria were observed in 88 patients. Receiver operating characteristic analyses in this group showed hs-cTnT levels of 732.3 pg/mL at ICU admission; 1008 pg/mL at 8 hours, 1057 pg/mL at 16 hours, and 958.3 pg/mL at 24 hours after surgery (P < .001) and CK-MB levels of 26.78 mg/dL at ICU admission, 54.88 mg/dL at 8 hours, 38.98 mg/dL at 16 hours, and 18.4 mg/dL at 24 hours after surgery (P < .001).
  
  
  
  Cut-offs for hs-cTnT and CK-MB to diagnose perioperative MI after heart valve surgery are well above upper reference limit. These findings update the Third Universal Definition providing cut-offs to diagnose perioperative MI after heart valve surgery.
authors.affiliation: Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Electronic address: hektorkubero@hotmail.com.
authors.forename: Héctor
authors.initials: H
authors.lastname: Cubero-Gallego
authors.affiliation: Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Heredia
authors.affiliation: Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Gómez
authors.affiliation: Anesthesiology and Critical Care Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D059035:Perioperative Period; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: Universal Definition; creatine-kinase MB; heart valve surgery; high-sensitivity troponin T; perioperative myocardial infarction