Determination of Troponin I Release After CABG Surgery

Noora, Joseph; Ricci, Christopher; Hastings, Deborah; Hill, Stephen A.; Cybulsky, Irene

doi:10.1111/j.0886-0440.2005.200387.x

Cited by 44 publications

(21 citation statements)

References 26 publications

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“…These include direct myocardial trauma from (i) suture place ment or manipulation of the heart, (ii) coronary dissec tion, (iii) global or regional ischemia related to inadequate intraoperative cardiac protection, (iv) micro vascular events related to reperfusion, (v) myocardial injury induced by oxygen free radical generation, or (vi) failure to reperfuse areas of the myocardium that are not sub tended by graftable vessels. [75][76][77] MRI studies suggest that most necrosis in this setting is not focal but diffuse and localized in the subendocardium. 78 In patients with normal values before surgery, any increase of cardiac biomarker values after CABG indicates myocardial necrosis, implying that an increasing magni tude of biomarker concentrations is likely to be related to an impaired outcome.…”

Section: Diagnostic Criteria For Myocardial Infarction With Cabg (Mi mentioning

confidence: 99%

Third universal definition of myocardial infarction

Thygesen

Alpert

Jaffe³

et al. 2012

Nat Rev Cardiol

3,502

1,749

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Section: Diagnostic Criteria For Myocardial Infarction With Cabg (Mi mentioning

confidence: 99%

Third universal definition of myocardial infarction

Thygesen

Alpert

Jaffe³

et al. 2012

Nat Rev Cardiol

3,502

1,749

View full text Add to dashboard Cite

Section: Diagnostic Criteria For Myocardial Infarction With Cabg (Mi mentioning

confidence: 99%

Third Universal Definition of Myocardial Infarction

Thygesen¹,

Alpert²,

White³

et al. 2012

Journal of the American College of Cardiology

2,495

924

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The term acute myocardial infarction (MI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia. Under these conditions any one of the following criteria meets the diagnosis for MI: ● Detection of a rise and/or fall of cardiac biomarker values [preferably cardiac troponin (cTn)] with at least one value above the 99th percentile upper reference limit (URL) and with at least one of the following: y Symptoms of ischemia. y New or presumed new significant ST-segment–T wave (ST–T) changes or new left bundle branch block (LBBB). y Development of pathological Q waves in the ECG. y Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. y Identification of an intracoronary thrombus by angiography or autopsy. ● Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic ECG changes or new LBBB, but death occurred before cardiac biomarkers were obtained, or before cardiac biomarker values would be increased. ● Percutaneous coronary intervention (PCI) related MI is arbitrarily defined by elevation of cTn values (5 99th percentile URL) in patients with normal baseline values (99th percentile URL) or a rise of cTn values 20% if the baseline values are elevated and are stable or falling. In addition, either (i) symptoms suggestive of myocardial ischemia or (ii) new ischemic ECG changes or (iii) angiographic findings consistent with a procedural complication or (iv) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required. ● Stent thrombosis associated with MI when detected by coronary angiography or autopsy in the setting of myocardial ischemia and with a rise and/or fall of cardiac biomarker values with at least one value above the 99th percentile URL. ● Coronary artery bypass grafting (CABG) related MI is arbitrarily defined by elevation of cardiac biomarker values (10 99th percentile URL) in patients with normal baseline cTn values (99th percentile URL). In addition, either (i) new pathological Q waves or new LBBB, or (ii) angiographic documented new graft or new native coronary artery occlusion, or (iii) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. Criteria for prior myocardial infarction Any one of the following criteria meets the diagnosis for prior MI: ● Pathological Q waves with or without symptoms in the absence of non-ischemic causes. ● Imaging evidence of a region of loss of viable myocardium that is thinned and fails to contract, in the absence of a non-ischemic cause. ● Pathological findings of a prior MI

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“…On the other hand, CRP levels before surgery did not prove to be useful in our study, because only patients with a noninflammatory condition were included. Diagnosis of perioperative myocardial infarction during cardiac surgery is problematic, as cTNI can be elevated because of nonischemic myocardial trauma due to the surgical procedure (28), and even electrocardiographic diagnosis can be impeded by the temporary use of pacemakers or the appearance of disturbances in electrical conductance in the myocardium. Thus, specificity and sensitivity for the markers evaluated have to be viewed with caution, and no definitive answer can be given as to which marker would be the best one in these patients.…”

Section: Discussionmentioning

confidence: 99%