Copyright © 2002 by the European Society of Cardiology.
Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting
a Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden
c Department of Cardiology, University Hospital, Uppsala, Sweden
b Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
revised January 22, 2002; accepted January 23, 2002
Abstract
Aims To establish the influence of perioperative myocardial injury on short- and long-term survival after coronary artery bypass grafting (CABG).
Methods and Results The correlation of postoperative serum aspartate aminotransferase and creatine kinase MB to early cardiac-related death and to late survival was evaluated in 4911 patients who underwent CABG consecutively during a 6-year period. There were 93 early deaths (1·9%), 73 of them cardiac-related (1·5% of 4911). After a mean follow-up of 5 years, 409 additional deaths (8·5% of 4818) had occurred. Elevated enzyme levels on day 1 postoperatively highly increased the risk of early cardiac death (serum aspartate aminotransferase 
2·35µkat.l–1: odds ratio 9·2; serum creatine kinase MB 61µg.l–1: odds ratio 6·0), and increased the risk of late death by approximately 50% (serum aspartate aminotransferase 2·35µkat.l–1: relative hazard 1·5; serum creatine kinase MB 61µg.l–1: relative hazard 1·4). This increased risk of death was independent of other risk factors and remained constant over time.
Conclusions Enzyme elevation after CABG implied an increased risk of both early and late death. The long-term effect persisted many years after surgery.Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .
Key Words: Myocardial injury, coronary surgery, serum aspartate aminotransferase, serum creatine kinase MB, survival
f1 Correspondence: Dr Johnny Steuer, Department of Cardiothoracic Surgery, University Hospital, S-751 85 Uppsala, Sweden.
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