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

Abstract

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.

Clinical and biochemical prediction of early fatal outcome following hip fracture in the elderly

“…Logistic regression analyses showed no correlation with postoperative mortality. This analysis suggests that CK and CK-MB are unspecific enzymes that are not distinct for skeletal and cardiac muscle damage following a hip fracture and are not feasible as prognostic markers of mortality, a finding consistent with other investigators [27]. …”

Comparison of Cardiac Troponin I versus T and Creatine Kinase MB after Coronary Artery Bypass Grafting in Patients with and without Perioperative Myocardial Infarction

“…Positive clinical symptoms are often absent or cannot be obtained [13], and ECG changes are often either unspecific or, because of pericardial inflammation or ventricular hypertrophy, difficult to interpret [9]. The specificity of some cardiac enzyme activities in patients after surgery is limited, because skeletal muscle injury due to the operative procedure may increase the postoperative concentrations or activities of some enzymes such as creatine kinase MB (CK-MB) [4]. Cardiac troponins have proven to be highly specific for cardiac myocyte damage [7,8,10,14,18].…”

Cardiac Management in the ICU

“…Frequent cardiac enzyme determinations (creatine phosphokinase, myocardial band [CK-MB]) are costly and may not add to the information gained from the 12-lead ECG in postoperative patients with clinical findings. 6 Troponin-t and troponin-i levels appear to be more cardiac specific, peak at a similar time as CK-MB, and stay elevated for days. 7 Studies are currently underway evaluating continuous 12lead ECG monitoring in postoperative patients, with the possibility that this might be done in a telemetry or surgical floor setting.…”