BACKGROUND: Significant myocardial injury during cardiac surgery is associated with a 10-fold increase in 2-year complication rates, yet there remains no clinical gold standard for diagnosis. Troponin I has complete cardiospecificity and is clinically used for diagnosis of myocardial infarction in other settings. METHODS AND RESULTS: One hundred consecutive patients undergoing open heart surgery (71 coronary artery bypass grafts and 29 aortic valve replacements) were enrolled and blood samples were drawn preoperatively, at 5 AM and 5 PM on days 1 and 2 after surgery, and at 5 AM for 3 more days. Twelve-lead electrocardiograms were performed daily and echocardiographic studies were performed on patients with either; electrocardiographic changes signifying likely myocardial damage, intraoperative complications, or elevated creatine kinase subfraction MB or troponin values. Seventeen patients had either new wall motion abnormalities or new Q waves all with peak cardiac troponin I >40 ng/mL. Stratification of patients by peak troponin values <40 and >60 ng/mL was highly predictive (P <.001) of days in intensive care unit, days on ventilator, development of new arrhythmia, and especially cardiac events. These postoperative variables also showed a stronger correlation with peak cardiac troponin I than did peak creatine kinase subfraction MB. CONCLUSION: Peak troponin I values detect myocardial infarction the day after heart surgery and predicts patient outcome.
BACKGROUND: Significant myocardial injury during cardiac surgery is associated with a 10-fold increase in 2-year complication rates, yet there remains no clinical gold standard for diagnosis. Troponin I has complete cardiospecificity and is clinically used for diagnosis of myocardial infarction in other settings. METHODS AND RESULTS: One hundred consecutive patients undergoing open heart surgery (71 coronary artery bypass grafts and 29 aortic valve replacements) were enrolled and blood samples were drawn preoperatively, at 5 AM and 5 PM on days 1 and 2 after surgery, and at 5 AM for 3 more days. Twelve-lead electrocardiograms were performed daily and echocardiographic studies were performed on patients with either; electrocardiographic changes signifying likely myocardial damage, intraoperative complications, or elevated creatine kinase subfraction MB or troponin values. Seventeen patients had either new wall motion abnormalities or new Q waves all with peak cardiac troponin I >40 ng/mL. Stratification of patients by peak troponin values <40 and >60 ng/mL was highly predictive (P <.001) of days in intensive care unit, days on ventilator, development of new arrhythmia, and especially cardiac events. These postoperative variables also showed a stronger correlation with peak cardiac troponin I than did peak creatine kinase subfraction MB. CONCLUSION: Peak troponin I values detect myocardial infarction the day after heart surgery and predicts patient outcome.
Authors: Jochen D Muehlschlegel; Kuang-Yu Liu; Tjörvi E Perry; Amanda A Fox; Charles D Collard; Stanton K Shernan; Simon C Body Journal: Circulation Date: 2010-09-14 Impact factor: 29.690
Authors: Ming Zhang; Yunfang Joan Hou; Erdal Cavusoglu; Daniel C Lee; Rudi Steffensen; Liming Yang; Daniel Bashari; Jose Villamil; Motaz Moussa; George Fernaine; Jens C Jensenius; Jonathan D Marmur; Wilson Ko; Ketan Shevde Journal: Int J Cardiol Date: 2011-12-15 Impact factor: 4.164
Authors: Jochen D Muehlschlegel; Tjörvi E Perry; Kuang-Yu Liu; Luigino Nascimben; Amanda A Fox; Charles D Collard; Edwin G Avery; Sary F Aranki; Michael N D'Ambra; Stanton K Shernan; Simon C Body Journal: Eur Heart J Date: 2009-04-30 Impact factor: 29.983
Authors: Jean-Michel Paradis; Hersh S Maniar; John M Lasala; Susheel Kodali; Mathew Williams; Brian R Lindman; Ralph J Damiano; Marc R Moon; Raj R Makkar; Vinod H Thourani; Vasilis Babaliaros; Ke Xu; Girma Minalu Ayele; Lars Svensson; Martin B Leon; Alan Zajarias Journal: JACC Cardiovasc Interv Date: 2015-09 Impact factor: 11.195