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Open Access 01-12-2017 | Research article

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

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

Published in: Journal of Cardiothoracic Surgery | Issue 1/2017

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.

Clinical trial registration

http://www.isrctn.com/ISRCTN09454308. Registered 08 May 2012.

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Title: Abnormal elevation of myocardial necrosis biomarkers after coronary artery bypass grafting without established myocardial infarction assessed by cardiac magnetic resonance
Authors: Fernando Teiichi Costa Oikawa
Whady Hueb
Cesar Higa Nomura
Alexandre Ciappina Hueb
Alexandre Volney Villa
Leandro Menezes Alves da Costa
Rodrigo Morel Vieira de Melo
Paulo Cury Rezende
Carlos Alexandre Wainrober Segre
Cibele Larrosa Garzillo
Eduardo Gomes Lima
Jose Antonio Franchini Ramires
Roberto Kalil Filho
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2017
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-017-0684-3

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Clinical trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Clinical trial registration

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