Diagnosis of Perioperative Myocardial Infarction with Measurement of Cardiac Troponin I

Adams, Jesse E.; Sicard, Gregorio A.; Allen, Bradley S.; Lenke, Lawrence G.; Dávila‐Román, Víctor G.; Bodor, G.; Ladenson, Jack H.; Jaffe, Allan S.

doi:10.1056/nejm199403103301003

Cited by 491 publications

(213 citation statements)

References 31 publications

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“…There is frequently absence of chest pain suggestive of ischaemic injury and there is release of CK-MB and other enzymes from noncardiac tissue. 7,8,10,11,26 Studies of outcomes following elective surgery have based their findings on changes in the ECG at the time of surgery~ 2-4,1s,27 and the impact of a positive CK-MB alone has not been adequately studied. The results of the present study suggest that, in the absence of ECG changes, the additional information provided did little to improve the diagnosis or therapy.…”

Section: Discussionmentioning

confidence: 99%

Postoperative elevation of creatine kinase (CK-MB): Does it contribute to diagnosis of myocardial infarction?

1997

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Purpose: This retrospective study sought to determine the benefr of measurement of changes in plasma creatine kinase -myocardial band (CK-MB) levels in elective postoperative high risk sur~=al patients beyond that obtained from the surface 12 lead ECG. .Mc'~r~ol~: The charts of I 1 I patients admitted to the surgical intensive care unit (SICU) of a tertiary level university teaching hospital were reviewed. They were screened using predetermined definitions of myocardial infection (MI) (as reflected by changes in the 12 lead surface ECG (Minnesota code) or elevations in CK-MB) for complications such as pulmonary oedema, congestive heart failure, arrhybhmias, or cardiogenic shock. Four groups were identified based on changes in the ECG indicative of MI (Present -ECG+ or Absent -ECG-) and elevations of CK-MB (Present -CKMB+ or Absent -CKMB-) and compared for the incidence of complications. ]P,J~ts: No patient with ECG-findings had a complication. F~een patients with ECG+ findings were identified and all had complications. Fourteen of these patients had CKMB+ results. In contrast, 29 patients with CKMB+ results alone (i.e., ECG-) had no complications. Conch~ion: Clinically important (i.e., requiring therapeutic intervention) postoperative myocardial infarction was detected by ECG changes. The benef~ of determining changes in CK-MB was minimal from a therapeutic perspective, Objectif : Cette 6rude retrospective visait A comparer les avantages,,,~ la pEriode postopEratoire, de la mesure des variations de la crEatine phosphokynase-MB (CK-MB) ~t ceux de I I~CG ~. 12 d~rivations chez des patients ,~ haut risque. M6-thodes : REvision des dossiers de II I patients admis ~ I'unitE des soins intensifs chirurgicaux d'un h6pital universitaire de soins tertiaires. Tout en utilisant les d~finitions prE~tablies de rinfarctus du myocarde (IM) (changernents ,~ I'I~CG A 12 derivations (code du Minnesota) ou augmentation de la CK-MB), on a recherche les complications comme I'oedEme pulmonaire, I'insuflisance cardiaque congestive, les arythmies ou le choc cardio, gEnique. Quatre grou~, s ont EtE identifies sur la base des changernents I~CG indicatifs de riM (IM present avec ECG+ ou absent avec ECG-) et des ElEvations de la CK-MB (IM present avec CPK-MB + ou absent avec CPK-MB-) et compares en rapport avec I'incidence des complications.

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Section: Discussionmentioning

confidence: 99%

Postoperative elevation of creatine kinase (CK-MB): Does it contribute to diagnosis of myocardial infarction?

1997

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“…When both mortality and morbidity data are considered, cardiac events occur in an estimated 1-5% of patients undergoing non-cardiac surgery, and the cardiovascular complication rate may reach 30% for patients undergoing vascular surgery 5,6 . In recent years the introduction of troponin assay for the diagnosis of perioperative MI [7][8][9][10][11][12][13][14] led to an apparent further increase in the frequency of perioperative MI from 1.4% with creatine kinase-MB assay to 6.6% 11 . In a retrospective study 15 performed on 869 patients who underwent major non-cardiac surgery, troponin I elevations (> 0.4 g/l) were observed among 38% of patients with significant intraoperative events such as hypotension, hypertension or unexpected blood loss or readmitted to the intensive care unit for an acute event on the ward.…”

Section: Immentioning

confidence: 99%

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

2006

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Advances in surgical and anaesthetic techniques and an aging patient population have resulted in more complex procedures being performed in greater numbers of aged subjects and in patients with a high likelihood of significant cardiovascular disease. Nearly one fourth of non-cardiac surgical procedures (major intra-abdominal, thoracic, vascular, and orthopaedic procedures) performed in persons older than 65 years have been found to be associated with significant perioperative cardiovascular morbidity and mortality. During previous years the main attempt was to define strategies to accurately estimate perioperative cardiovascular risk based either on the characteristics of surgery and on patient characteristics. More recently preventive medical strategies have been proposed. Therefore, the physician has to be aware of the key elements useful to calculate the perioperative cardiovascular risk, and of the medical preventive treatment or further interventions to adopt in patients candidate to surgery.

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“…It is an inhibiting molecule of adenosine triphosphate of the actin-myosin complex in cardiac muscle cells. It is highly specific to determine myocardial lesion [3,4] and it is about 13 times more abundant in the myocardium than CKMB [8].…”

Section: Commentsmentioning

confidence: 99%

“…Troponin is a regulating molecule of the actin-myosin complex in the cardiac cell and is highly specific for the determination of myocardial lesion [3,4]. Determination of the peri-operative increases of cardiac enzymes is related to an increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

Prognostic implications of myocardial creatine kinase and cardiac troponin in coronary artery bypass surgery

Taniguchi¹,

Pěgo‐Fernandes²,

Jatene³

et al. 2003

Rev Bras Cir Cardiovasc

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Objectives: To evaluate the prognostic implications of myocardial creatine kinase and troponin I (cTn I) in blood samples from the coronary sinus of patients submitted to coronary artery bypass surgery both with and without ischemic preconditioning.Methods: From October 1998 to May 1999, 35 patients with coronary artery disease who were submitted to coronary artery bypass surgery were studied. Samples containing creatine kinase and cTn I were obtained from the great cardiac vein during surgery at the onset of cardiopulmonary bypass, at the end of the first anastomosis, and at the end of cardiopulmonary bypass. In May 2002, 29 patients were evaluated in regards to the angina functional class, congestive heart failure, number of hospitalizations, myocardial infarction and death. There were 15 patients in the Preconditioned group and 14 in the Control group. Each group was subdivided into patients with and without cardiovascular symptoms. Results:The Control and Preconditioned groups were not significantly different in relation to frequency of cardiovascular symptoms. There were progressive increases of the creatine kinase and cTn I levels at different Interval s of the study. The cTn I in the Preconditioned group was 1.21 ± 0.64 ng/mL and 3.19 ± 3.21 ng/mL in the Control group (p<0.05). The Control group with symptoms had the highest level for cTn I of 5.07 ± 3.69 ng/mL, significantly higher than all other groups (p<0.05).Conclusions: The Preconditioned group had the lowest level of cTn I. The cTn I may be a marker for late evolution in patients submitted to coronary artery bypass surgery.Descriptors: Myocardial revascularization. Myocardial ischemic preconditioning. Myocardial ischemia, physiology. Troponin. Cardiovasc 2003; 18(3): 210-216 Rev Bras Cir

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Diagnosis of Perioperative Myocardial Infarction with Measurement of Cardiac Troponin I

Abstract: The measurement of cardiac troponin I is a sensitive and specific method for the diagnosis of perioperative myocardial infarction. It avoids the high incidence of false diagnoses associated with the use of MB creatine kinase as a diagnostic marker.

Cited by 491 publications

References 31 publications

Postoperative elevation of creatine kinase (CK-MB): Does it contribute to diagnosis of myocardial infarction?

Postoperative elevation of creatine kinase (CK-MB): Does it contribute to diagnosis of myocardial infarction?

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

Prognostic implications of myocardial creatine kinase and cardiac troponin in coronary artery bypass surgery

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