European Heart Journal Advance Access published online on August 8, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi437
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1 Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital of Essen, Hufelandstraße 55, 45122 Essen, Germany
* To whom correspondence should be addressed. 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.
Received December 21, 2004
Revised June 8, 2005
Accepted July 7, 2005
Clinical research
Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery
2 Department of Cardiology, West-German Heart Center Essen, University Hospital of Essen, Essen, Germany
3 Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, Essen, Germany
4 Department of Clinical Chemistry, University Hospital of Essen, Essen, Germany
5 Institute of Pathophysiology, University Hospital of Essen, Essen, Germany
Matthias Thielmann, E-mail: matthias.thielmann{at}uni-essen.de
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