Does Perioperative Myocardial Ischemia Lead to Postoperative Myocardial Infarction?

Slogoff, Stephen; Keats, Arthur S.

doi:10.1097/00000542-198502000-00002

Cited by 609 publications

(100 citation statements)

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“…Accordingly, an overall PMI rate of 35.7% in this series of patients was reported. The authors believe that this is a more accurate estimate of perioperative myocardial injury than previously published estimates 3,4,6 because it includes all grades of ischemic injury rather than just transmural MIs. The authors found that a cTn-I value of Ն15 g/L had a sensitivity (true-positive rate) of 92.5% and a specificity (true-negative rate) of 88.9% for the diagnosis of PMI, which the authors believe are acceptable parameters for use in routine clinical practice.…”

Section: Discussionmentioning

confidence: 75%

“…This is of concern when a high value for a test is presumably indicative of increasing severity of pathology. If a laboratory changes its assay without warning then there is the possibility for over-or, even worse, underdiagnosis of PMI, especially because the adverse relationship that exists between PMI and patient outcome [1][2][3][4][5][6][7][8][9]17 is increasingly recognized and may warrant early intervention. Accordingly, an overall PMI rate of 35.7% in this series of patients was reported.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate diagnosis and timely intervention of perioperative myocardial infarction (PMI) are vital because major ischemic injury is associated with reduced hospital [1][2][3][4] and long-term 5,6 survival. Similarly, more recent data suggest that minor ischemic injury after CABG surgery is also associated with adverse short-term 7,8 and medium-term 9 outcome.…”

Section: Espite Advances In Myocardial Protective Strate-mentioning

confidence: 99%

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The Comparison and Validity of Troponin I Assay Systems in Diagnosing Myocardial Ischemic Injury After Surgical Coronary Revascularization

Martin

Shaw

Gál

et al. 2005

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: A prospective observational study was conducted to test the agreement between 2 commercially available automated cardiac troponin-I immunoassay systems (Opus Plus, Behring Diagnostics UK Ltd, Hounslow, UK; Ax-SYM, Abbott Laboratories, Abbott Park, IL) and to determine a normal reference range and threshold value indicative of perioperative myocardial infarction (PMI) after elective coronary artery bypass graft (CABG) surgery for the Opus Plus system.Design: Prospective, observational study. Setting: Single institution, cardiothoracic specialty hospital.Participants: Seventy patients undergoing elective CABG surgery.Interventions: After institutional review board approval, patients received standardized anesthetic, surgical, and myocardial preservation techniques. Serial electrocardiographs, creatine kinase-MB, troponin-I, and perioperative outcome data were collected. Correlation between the immunoassay systems was tested using 124 duplicate samples from the first 18 patients. The normal reference range and threshold value indicative of PMI were tested for the Opus Plus system using duplicate samples from all 70 patients. There was clear proportional bias that was corrected with log transformation of the raw data. By using confidence interval and receiver operating characteristic curve analysis, the authors showed that a value >15 g/L was indicative of PMI (Opus Plus system) and accordingly report a 35.7% (2.9% Q-wave) overall incidence of PMI in this study population (n ‫؍‬ 70). Measurements and MainConclusions: These data highlight differences between commercially available troponin-I assay systems. The authors recommend that each institution establish a local reference range and threshold indicative of perioperative myocardial infarction for its specific patient population and assay system and provide sample methodology. © 2005 Elsevier Inc. All rights reserved.KEY WORDS: coronary artery bypass graft surgery, perioperative myocardial infarction, troponin-I, receiver operating characteristic curve analysis D ESPITE ADVANCES IN myocardial protective strategies, ischemic injury often complicates coronary artery bypass graft (CABG) surgery. Accurate diagnosis and timely intervention of perioperative myocardial infarction (PMI) are vital because major ischemic injury is associated with reduced hospital 1-4 and long-term 5,6 survival. Similarly, more recent data suggest that minor ischemic injury after CABG surgery is also associated with adverse short-term 7,8 and medium-term 9 outcome. Accurate assessment of ischemic injury will facilitate the comparison and optimization of myocardial protective strategies with further improved surgical outcome.The Joint European Society of Cardiology/American College of Cardiology Committee for redefinition of myocardial infarction (MI) currently considers cardiac troponin isozyme (cTn) as the biomarker of choice for myocardial injury. 10 This is on account of the improved sensitivity and specificity of cTn for acute MI, both nonsurgical 11,12 and perioperative 7,13-1...

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Espite Advances In Myocardial Protective Strate-mentioning

confidence: 99%

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The Comparison and Validity of Troponin I Assay Systems in Diagnosing Myocardial Ischemic Injury After Surgical Coronary Revascularization

Martin

Shaw

Gál

et al. 2005

Journal of Cardiothoracic and Vascular Anesthesia

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“…3 Early detection of myocardial ischaemia may allow the clinician to intervene before an adverse outcome occurs. There are.…”

Section: 6%) a L'ecg (Derivation V Set Ii) La Mesures De I'isch~mimentioning

confidence: 99%

Detection of intraoperatiye myocardial ischaemia — a comparison among electrocardiographic, myocardial metabolic, and haemodynamic measurements in patients with reduced ventricular function

Hall

O'Regan²,

Gardner

1995

Can J Anaesth

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“…Preoperative ß-blocker therapy has been shown to reduce the incidence of intraoperative ischemic events related to increases in heart rate (4,5) and hemodynamic responses to surgical stimulation during revascularization of the myocardium. Administration of a ß-blocker before coronary bypass and its immediate reinstitution afterwards is considered to be safe and beneficial (6,7), whereas an abrupt withdrawal of the drug has been associated with myocardial ischemia, hypertension, and tachydysrhythmias secondary to a ß-blockade-induced increase in ß-receptor density (8).…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

Carmona

Malbouisson

Pereira

et al. 2005

Braz J Med Biol Res

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The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m 2 ), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by highperformance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre-and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min -1 kg -1 (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

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Does Perioperative Myocardial Ischemia Lead to Postoperative Myocardial Infarction?

Cited by 609 publications

References 0 publications

The Comparison and Validity of Troponin I Assay Systems in Diagnosing Myocardial Ischemic Injury After Surgical Coronary Revascularization

The Comparison and Validity of Troponin I Assay Systems in Diagnosing Myocardial Ischemic Injury After Surgical Coronary Revascularization

Detection of intraoperatiye myocardial ischaemia — a comparison among electrocardiographic, myocardial metabolic, and haemodynamic measurements in patients with reduced ventricular function

Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery

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