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Myocardial injury after off-pump coronary artery bypass grafting operation.
Eur J Cardiothorac Surg. 2007 Sep; 32(3):481-7.EJ

Abstract

OBJECTIVE

Perioperative myocardial ischemia is less pronounced in off-pump coronary artery bypass (OPCAB) compared to on-pump coronary artery bypass; however, the threshold over which the postoperative release of cardiac troponin I (cTnI) release and creatine kinase-MB (CK-MB) after OPCAB should be considered clinically relevant is unknown. The study was designated to evaluate if perioperative myocardial damage, measured by means of postoperative release of cTnI and CK-MB, has an influence on short- and mid-term outcome after OPCAB operations.

METHODS

Two hundred and sixty-one unselected patients undergoing OPCAB had cTnI and CK-MB measured preoperatively and nine times postoperatively. Postoperative peak values were evaluated and the 80th percentiles were used to segregate the population into two groups for each marker. The following cut-offs were used: 7.1 ng/dl for cTnI peak and 36.3 ng/dl for CK-MB peak.

RESULTS

Patients with cTnI>7.1 ng/ml (n=51) and CK-MB>36.3 ng/ml (n=48) had a longer mechanical ventilation and ICU length of stay. Nevertheless, hospital mortality did not differ between groups. Survival after 3 years was 92.8+/-2.3% and 81.8+/-6.2 for patients with postoperative cTnI peak<or=7.1 ng/ml and >7.1 ng/ml, respectively (p=0.003). It was 93+/-2.2% and 80+/-6.8% for patients with CK-MB<or=36.3 ng/ml and >36.3 ng/ml, respectively (p=0.005). Adjusted hazard ratios for mid-term mortality were HR 2.7 (CI 1-7.6), p=0.05 for cTnI>7.1 ng/dl and HR 3.1 (CI 1-9.1), p=0.04 for CK-MB>36.3 ng/ml.

CONCLUSION

Perioperative myocardial damage should not be considered an innocuous event following OPCAB operations since the survival rate over 3 years is significantly worse in patients with the highest postoperative peak release of cTnI and CK-MB.

Authors+Show Affiliations

Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Italy. dpaparella@cardiochir.uniba.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17643993

Citation

Paparella, Domenico, et al. "Myocardial Injury After Off-pump Coronary Artery Bypass Grafting Operation." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 32, no. 3, 2007, pp. 481-7.
Paparella D, Cappabianca G, Malvindi P, et al. Myocardial injury after off-pump coronary artery bypass grafting operation. Eur J Cardiothorac Surg. 2007;32(3):481-7.
Paparella, D., Cappabianca, G., Malvindi, P., Paramythiotis, A., Galeone, A., Veneziani, N., Fondacone, C., & de Luca Tupputi Schinosa, L. (2007). Myocardial injury after off-pump coronary artery bypass grafting operation. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 32(3), 481-7.
Paparella D, et al. Myocardial Injury After Off-pump Coronary Artery Bypass Grafting Operation. Eur J Cardiothorac Surg. 2007;32(3):481-7. PubMed PMID: 17643993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myocardial injury after off-pump coronary artery bypass grafting operation. AU - Paparella,Domenico, AU - Cappabianca,Giangiuseppe, AU - Malvindi,Piergiorgio, AU - Paramythiotis,Andreas, AU - Galeone,Antonella, AU - Veneziani,Nicola, AU - Fondacone,Corrado, AU - de Luca Tupputi Schinosa,Luigi, Y1 - 2007/07/23/ PY - 2007/03/19/received PY - 2007/05/29/revised PY - 2007/06/14/accepted PY - 2007/7/24/pubmed PY - 2008/2/15/medline PY - 2007/7/24/entrez SP - 481 EP - 7 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 32 IS - 3 N2 - OBJECTIVE: Perioperative myocardial ischemia is less pronounced in off-pump coronary artery bypass (OPCAB) compared to on-pump coronary artery bypass; however, the threshold over which the postoperative release of cardiac troponin I (cTnI) release and creatine kinase-MB (CK-MB) after OPCAB should be considered clinically relevant is unknown. The study was designated to evaluate if perioperative myocardial damage, measured by means of postoperative release of cTnI and CK-MB, has an influence on short- and mid-term outcome after OPCAB operations. METHODS: Two hundred and sixty-one unselected patients undergoing OPCAB had cTnI and CK-MB measured preoperatively and nine times postoperatively. Postoperative peak values were evaluated and the 80th percentiles were used to segregate the population into two groups for each marker. The following cut-offs were used: 7.1 ng/dl for cTnI peak and 36.3 ng/dl for CK-MB peak. RESULTS: Patients with cTnI>7.1 ng/ml (n=51) and CK-MB>36.3 ng/ml (n=48) had a longer mechanical ventilation and ICU length of stay. Nevertheless, hospital mortality did not differ between groups. Survival after 3 years was 92.8+/-2.3% and 81.8+/-6.2 for patients with postoperative cTnI peak<or=7.1 ng/ml and >7.1 ng/ml, respectively (p=0.003). It was 93+/-2.2% and 80+/-6.8% for patients with CK-MB<or=36.3 ng/ml and >36.3 ng/ml, respectively (p=0.005). Adjusted hazard ratios for mid-term mortality were HR 2.7 (CI 1-7.6), p=0.05 for cTnI>7.1 ng/dl and HR 3.1 (CI 1-9.1), p=0.04 for CK-MB>36.3 ng/ml. CONCLUSION: Perioperative myocardial damage should not be considered an innocuous event following OPCAB operations since the survival rate over 3 years is significantly worse in patients with the highest postoperative peak release of cTnI and CK-MB. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/17643993/Myocardial_injury_after_off_pump_coronary_artery_bypass_grafting_operation_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2007.06.015 DB - PRIME DP - Unbound Medicine ER -