Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: a study using biomarkers and cardiac magnetic resonance imaging (original) (raw)
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Journal of Cardiac Surgery, 2008
Background: Determination of cardiac markers can assess cardiac injury induced by cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG). However, the markers and their release pattern are not well defined. This study was aimed at assessing the release and timing of cardiac biochemical and inflammatory markers in patients undergoing elective CABG with CPB. Methods: Forty patients undergoing elective CABG were included in this study. Blood samples were collected for biochemical measurements at the following time points: immediately prior to the induction of anesthesia, one, six, 12, and 24 hours after initiation of CPB. Results: Increased release of cardiac troponin I was observed one hour after initiation of CPB (p < 0.05) and reached the maximum at 12 hours after CPB (p < 0.01). Serum CK-MB enzyme activity and CK-MB mass both were highly elevated starting at one hour after initiation of CPB, peaked at six hours, and remained elevated until 24 hours after CPB. Both lactate and lactate dehydrogenase were highly elevated six hours after CPB and peaked at 12 hours after CPB (p < 0.01). Serum levels of interleukin-6 and tumor necrosis factor-α increased significantly one hour after initiation of CPB and peaked at six hours (p < 0.01), while serum high sensitivity C-reactive protein levels started to elevate 12 hours after CPB (p < 0.01). Conclusion: Monitoring of these markers could help to determine implementation of protective interventions during CABG with CPB to prevent myocardial deterioration and to predict the risk and prognosis.
Determinants and Prognosis of Myocardial Damage After Coronary Artery Bypass Grafting
The Annals of Thoracic Surgery, 2005
Background. Myocardial infarction remains a devastating complication after coronary revascularization. Although electrocardiography (ECG) and echocardiography suggest transmural infarction, myocardial damage and the quality of myocardial protection are not recognized unless troponin I (TnI) is assessed. Determinants and prognosis of TnI elevation after coronary artery bypass grafting (CABG) were evaluated.
Chest, 2002
Study objectives: Perioperative myocardial infarction (PMI) during coronary artery bypass grafting (CABG) is an important clinical problem because it is closely associated with increased morbidity and mortality. The diagnosis of PMI is, however, associated with several problems. Due to the surgical trauma, the usual indicators of myocardial infarction (pain, ECG changes, and elevated biochemical markers of infarction) have uncertain diagnostic value. The primary aim of this study was to illustrate the levels of the biochemical markers after uncomplicated bypass surgery defined as no clinical or ECG evidence of PMI, and no graft occlusion at 7 days by repeat angiography; and secondarily, to establish biochemical diagnostic discrimination limits for detection of in-hospital graft occlusion. Methods and results: One hundred three patients undergoing elective CABG were closely monitored by serial measurements of creatine kinase (CK)-MB mass, myoglobin, troponin T, and troponin I, and underwent a repeat angiography before discharge. Seven patients had ECG evidence of PMI. Peak troponin T and CK-MB values were significantly higher in these seven patients, although the diagnostic performances of the optimally chosen cutoff levels for diagnosing AMI were fair. Twelve patients had at least one occluded graft shown by repeat angiography. Peak values of CK-MB and troponin T were significantly higher in patients with graft occlusion (52.2 g/L vs 24.7 g/L, p ؍ 0.01; and 3.7 g/L vs 1.0 g/L, p ؍ 0.05, respectively). By multivariate analysis, a diagnostic discrimination level of 30 g/L for CK-MB did not reach statistical significance; however, the independent diagnostic value of a cutoff level for troponin T at 3 g/L reached a level of significance (p ؍ 0.06). Discussion: We have suggested normal values of four different biochemical markers of infarction after uncomplicated coronary bypass surgery. Patients with in-hospital graft occlusion had higher peak CK-MB and troponin T values. However, the overlap with patients without graft occlusion is substantial, and the patency status in the individual cannot be reliably predicted from these noninvasive tests.
World Journal of Cardiovascular Surgery, 2020
Background: Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, post-operatively after 1 hour, post-operatively after 4 hours and post-operatively after 20 hours. All recorded data are analyzed using standard statistical methods. Results: We found the markers are elevated immediately after surgery and gradually come down within 24 hours after surgery in both OPCAB and ONCAB groups. The elevation is more after ONCAB than OPCAB group in immediate post-operative period but the difference is not significant after 20 hours of surgery. Conclusion: Elevated levels of cardiac biomarkers in the immediate post-operative period indicate myocardial damage during surgery, especially after ONCAB in comparison to OPCAB.
Myocardial inflammation, injury and infarction during on-pump coronary artery bypass graft surgery
Journal of cardiothoracic surgery, 2017
Myocardial inflammation and injury occur during coronary artery bypass graft (CABG) surgery. We aimed to characterise these processes during routine CABG surgery to inform the diagnosis of type 5 myocardial infarction. We assessed 87 patients with stable coronary artery disease who underwent elective CABG surgery. Myocardial inflammation, injury and infarction were assessed using plasma inflammatory biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and cardiac magnetic resonance imaging (CMR) using both late gadolinium enhancement (LGE) and ultrasmall superparamagnetic particles of iron oxide (USPIO). Systemic humoral inflammatory biomarkers (myeloperoxidase, interleukin-6, interleukin-8 and c-reactive protein) increased in the post-operative period with C-reactive protein concentrations plateauing by 48 h (median area under the curve (AUC) 7530 [interquartile range (IQR) 6088 to 9027] mg/L/48 h). USPIO-defined cellular myocardial inflammation ranged from normal to those ass...
European Journal of Cardio-Thoracic Surgery, 2000
In coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) the in¯ammatory response is suggested to be minimized. Coronary anastomoses are performed during temporary coronary occlusion. In¯ammatory response and myocardial ischaemia need to be studied in a randomized study comparing CABG in multivessel disease with versus without CPB. Methods: Following randomization 30 consecutive patients received CABG either with (n 16) or without CPB (n 14). Primary study endpoints were parameters of the in¯ammatory response (interleukin (IL)-6, interleukin-10, ICAM-1, P-selectin) and of myocardial injury (myoglobin, creatine kinase-MB (CK-MB), troponin I) (intraoperatively, 4, 8, 16, 24 and 48 h after surgery). The secondary endpoint was clinical outcome. Results: The incidence of major (death: CABG with CPB n 1, not signi®cant (n.s.)) and minor adverse events (wound infection: with CPB n 2, without CPB n 1, n.s.; atrial ®brillation: with CPB n 3, without CPB n 2, n.s.) was comparable between both groups. The release of IL-6 was comparable during 8 h of observation (n.s.). Immediately postoperatively IL-10 levels were higher in the operated group with CPB (211.7^181.9 ng/ml) than in operated patients without CPB (104.6^40.3 ng/ml, P 0:0017). Thereafter no differences were found between both groups. A similar pattern of release was observed in serial measures of ICAM-1 and P-selectin, with no difference between both study groups (n.s.). Eight hours postoperatively the cumulative release of myoglobin was lower in operated patients without CPB (1829.7^1374.5 mg/l) than in operated patients with CPB (4469.8^4525.7 mg/l, P 0:0152). Troponin I release was 300.7^470.5 mg/l (48 h postoperatively) in patients without CPB and 552.9^527.8 mg/l (P 0:0213). CK-MB mass release was 323.5^221.2 mg/l (24 h postoperatively) in operated patients without CPB and 1030.4^1410.3 mg/l in operated patients with CPB (P 0:0003). Conclusions: This prospective randomized study suggests that in low-risk patients the impact of surgical access on in¯ammatory response may mimic the in¯uence of long cross-clamp and perfusion times on in¯ammatory response. Our ®ndings indicate that multiregional warm ischaemia, caused by snaring of the diseased coronary artery, causes considerably less myocardial injury than global cold ischaemia induced by cardioplegic cardiac arrest.