Abnormal elevation of myocardial necrosis biomarkers after coronary artery bypass grafting without established myocardial infarction assessed by cardiac magnetic resonance

Author(s):Show less -

Costa Oikawa, Fernando Teiichi ^[1] ; Hueb, Whady ^[1] ; Nomura, Cesar Higa ^[1] ; Hueb, Alexandre Ciappina ^[1] ; Villa, Alexandre Volney ^[1] ; Alves da Costa, Leandro Menezes ^[1] ; Vieira de Melo, Rodrigo Morel ^[1] ; Rezende, Paulo Cury ^[1] ; Wainrober Segre, Carlos Alexandre ^[1] ; Garzillo, Cibele Larrosa ^[1] ; Lima, Eduardo Gomes ^[1] ; Franchini Ramires, Jose Antonio ^[1] ; Filho, Roberto Kalil ^[1]

Affiliation

^[1] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Ciencias, Inst Coracao InCor, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: JOURNAL OF CARDIOTHORACIC SURGERY; v. 12, DEC 29 2017.
• Web of Science Citations: 0

Abstract

Background: The diagnosis of peri-procedural myocardial infarction is complex, especially after the emergence of high-sensitivity markers of myocardial necrosis. Methods: In this study, patients with normal baseline cardiac biomarkers and formal indication for elective on-pump coronary bypass surgery were evaluated. Electrocardiograms, cardiac biomarkers, and cardiac magnetic resonance imaging with late gadolinium enhancement were performed before and after procedures. Myocardial infarction was defined as more than ten times the upper reference limit of the 99th percentile for troponin I and for creatine kinase isoform (CK-MB) and by the findings of new late gadolinium enhancement on cardiac magnetic resonance. We assessed the release of cardiac biomarkers in patients with no evidence of myocardial infarction on cardiac magnetic resonance. Results: Of 75 patients referred for on-pump coronary bypass surgery, 54 (100%) did not have evidence of myocardial infarction on cardiac magnetic resonance. However, all had a peak troponin I above the 99th percentile; 52 (96%) had an elevation 10 times higher than the 99th percentile. Regarding CK-MB, 54 (100%) patients had a peak CK-MB above the 99th percentile limit, and only 13 (24%) had an elevation greater than 10 times the 99th percentile. The median value of troponin I peak was 3.15 (1.2 to 3.9) ng/mL, which represented 78.7 times the 99th percentile. Conclusion: In this study, different from CK-MB findings, troponin was significantly increased in the absence of myocardial infarction on cardiac magnetic resonance. Thus, CK-MB was more accurate than troponin I for excluding procedure-related myocardial infarction. These data suggest a higher troponin cutoff for the diagnosis of coronary bypass surgery related myocardial infarction. (AU)

• FAPESP's process: 11/20876-2 - Increase in biomarkers of myocardial necrosis after surgical or percutaneous revascularization in the absence of demonstrated myocardial infarction
• Grantee: Whady Armindo Hueb
• Support Opportunities: Regular Research Grants