Title: Patterns and Diagnostic Value of Cardiac Troponin I vs. Troponin T and CKMB after OPCAB Surgery*
Abstract: Background: Cardiac troponin I (cTnI) has been shown to be a specific marker for myocardial injury in cardiac surgery. The object of this prospective study was to determine the patterns and kinetic and diagnostic value of cTnI, cardiac troponin T (cTnT), and creatine kinase MB (CKMB) activity after minimally invasive coronary revascularization using an octopus device on the beating heart (OPCAB). Methods: 48 patients (33 male/15 female, mean age 68.3 ± 8.7 years) underwent their first elective OPCAB surgery with median sternotomy without mortality. The mean number of grafts was 2.0 ± 0.8 per patient. Preoperative mean ejection fraction was 56.6 % ± 14.9 %. CTnI and T levels, total creatine kinase (CK) and CK-MB activity in the serum were measured before operation, at arrival at the ICU, and 6, 12, 24, 48 and 120 hours afterward. Serial 12-lead ECGs were recorded preoperatively and at days 1, 2 and 5. The relationship between perioperative data and postoperative cTnI and cTnT levels and CKMB were statistically identified for all variables. Results: The best cutoff value for cTnI was 8.35 µg/l. The patients were grouped by the ECG findings and maximal slopes of cTnI postoperatively (group I: unchanged ECG and cTnI < 8.35 µg/l, n = 38; group II: unchanged ECG and cTnI > 8.35 µg/l n = 6; group III: Q-wave in ECG and cTnI > 8.35 µg/l, n = 4). Baseline serum concentrations of cTnI were in the normal range, and significantly increased after surgery with a peak 24 h after the operation. Maximal slopes of cTnI ranged in group II between 9.1 and 18.0 µg/l, and in group III between 35.9 and 88.8 µg/l. There was a strong concordance between maximum cTnI, cTnT (p < 0.0001) and CK-MB levels (p = 0.003). First cTnI levels immediately post-op correlated with the maximum cTnI levels during the postoperative course (p = 0.009). Conclusions: CTnI after minimal invasive surgery shows a characteristic pattern with a maximum at 24 h after the operation. The measurement of postoperative biochemical marker concentrations, specially cTnI, reflects myocardial injury incurred during the procedure. It is an accurate method for confirming or excluding a perioperative myocardial injury diagnosis after OPCAB surgery.
Publication Year: 2001
Publication Date: 2001-06-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 15
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