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European Heart Journal Advance Access originally published online on August 8, 2005
European Heart Journal 2005 26(22):2440-2447; doi:10.1093/eurheartj/ehi437
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery

Matthias Thielmann1,*, Parwis Massoudy1, Axel Schmermund2, Markus Neuhäuser3, Günter Marggraf1, Markus Kamler1, Ulf Herold1, Ivan Aleksic1, Klaus Mann4, Michael Haude2, Gerd Heusch5, Raimund Erbel2 and Heinz Jakob1

1Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital of Essen, Hufelandstraße 55, 45122 Essen, Germany
2Department of Cardiology, West-German Heart Center Essen, University Hospital of Essen, Essen, Germany
3Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, Essen, Germany
4Department of Clinical Chemistry, University Hospital of Essen, Essen, Germany
5Institute of Pathophysiology, University Hospital of Essen, Essen, Germany

Received 21 December 2004; revised 8 June 2005; accepted 7 July 2005; online publish-ahead-of-print 8 August 2005.

* Corresponding author. Tel: +49 201 723 4901; fax: +49 201 723 5451. E-mail address: matthias.thielmann{at}uni-essen.de

Aims The rise of markers for myocardial injury indicates early graft-related or non-graft-related perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG). A diagnostic discrimination between these two situations may enable adequate therapeutic measures, limiting myocardial damage, and improving outcome.

Methods and results In a prospective study, 94 among 3308 consecutive CABG patients underwent acute reangiography because of evidence of PMI. Of these 94 patients, 56 had graft-related PMI (group 1), 38 patients had non-graft-related PMI (group 2), and 95 patients without evidence of PMI and angiographically patent grafts served as control (group 3). Cardiac troponin I (cTnI), creatine kinase (CK), and its MB fraction were determined. CTnI, but not CK/CK-MB levels were significantly higher in group 1 than in groups 2 and 3 at 12 and 24 h after aortic unclamping (P<0.0001). Receiver operating characteristic and multivariable logistic regression analyses indicated cTnI as the best discriminator between PMI ‘in general’ and ‘inherent’ release of cTnI after CABG with a cut-off value of 10.5 ng/mL and between graft-related and non-graft-related PMI with a cut-off value of 35.5 ng/mL.

Conclusion Perioperative cTnI elevation after CABG separates among patients with graft-related, non-graft-related, and without PMI, however, not earlier than 12 h after surgery.

Key Words: Coronary artery disease • Surgery • Myocardial infarction • Bypass graft failure


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