Document Detail

Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: a study using biomarkers and cardiac magnetic resonance imaging.
MedLine Citation:
PMID:  21962261     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Myocardial injury related to coronary artery bypass grafting (CABG) is poorly characterized, and understanding the characteristic release of biomarkers associated with revascularization injury might provide novel therapeutic opportunities. This study characterized early changes in biomarkers after revascularization injury during on-pump CABG.
METHODS: This prospective study comprised 28 patients undergoing on-pump CABG and late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) who underwent measurements of cardiac troponin I (cTnI), creatine kinase-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, interleukin 6, tumor necrosis factor-α, matrix metalloproteinase 9a, monocyte chemotactic protein-1, plasminogen activator inhibitor-1a) at baseline, at 1, 6, 12, and 24 hours, and at 1 week (inflammatory markers only) post-CABG. Biomarker results at 1 hour were studied for a relationship to new myocardial infarction as defined by CMRI-LGE, and the diagnostic utility of combining positive biomarkers was assessed.
RESULTS: All patients had an uneventful recovery, but 9 showed a new myocardial infarction demonstrated by new areas of hyperenhancement on CMR. Peak cTnI at 24 hours (ρ = 0.66, p < 0.001) and CK-MB (ρ = 0.66, p < 0.001) correlated with the amount of new LGE. At 1 hour, 3 biomarkers--cTnI, interleukin 6, and tumor necrosis factor-α--were significantly elevated in patients with vs those without new LGE. Receiver operating curve analysis showed cTnI was the most accurate at detecting new LGE at 1 hour: a cutoff of cTnI exceeding 5 μg/L at 1 hour had 67% sensitivity and 79% specificity for detecting new LGE.
CONCLUSIONS: Unexpected CABG-related myocardial injury occurs in a significant proportion of patients. A cTnI test at 1 hour after CABG could potentially differentiate patients with significant revascularization injury.
Chris C S Lim; Florim Cuculi; William J van Gaal; Luca Testa; Jayanth R Arnold; Theodoros Karamitsos; Jane M Francis; Janet E Digby; Charalambos Antoniades; Rajesh K Kharbanda; Stefan Neubauer; Stephen Westaby; Adrian P Banning
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-01
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  92     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-25     Completed Date:  2012-01-17     Revised Date:  2014-06-10    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  2046-53     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Biological Markers / blood
Coronary Artery Bypass / adverse effects*
Early Diagnosis
Magnetic Resonance Imaging / methods*
Middle Aged
Myocardial Infarction / diagnosis*
Perioperative Period
Prospective Studies
ROC Curve
Grant Support
090532//Wellcome Trust; //British Heart Foundation; //Medical Research Council
Reg. No./Substance:
0/Biological Markers
Comment In:
Ann Thorac Surg. 2011 Dec;92(6):2053   [PMID:  22115217 ]
Ann Thorac Surg. 2012 Sep;94(3):1035-6; author reply 1036   [PMID:  22916768 ]

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