Utility of cardiac biomarkers for the diagnosis of type V myocardial infarction after coronary artery bypass grafting: insights from serial cardiac MRI

Pegg, Tammy; Maunsell, Zoë; Karamitsos, Theodoros D.; Taylor, Richard; James, Tim; Francis, Jane M; Taggart, David P.; White, Harvey D.; Neubauer, Stefan; Selvanayagam, Joseph B.

doi:10.1136/hrt.2010.213462

Cited by 56 publications

(39 citation statements)

References 27 publications

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“…To help provide useful and more timely differential data, some workers have been looking at techniques to assess preoperative risk other than clinical outcomes such as per-operative injury to the left ventricular myocardium. This is hard to quantify and was the subject of a recent study from Oxford in which 40 patients underwent cardiac MR before and after CABG with serial assessment of troponin I (TnI) 39. TnI correlated closely with the mass of new cardiac MR necrosis (r=0.83, p<0.001), with sensitivity and specificity values of 75% and 87%, making it a robust means of diagnosing this type of MI.…”

Section: Should Bilateral Internal Mammary Artery Grafts Be Used For mentioning

confidence: 99%

Almanac 2012—adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology

Bridgewater¹

2012

Heart

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This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.

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Section: Should Bilateral Internal Mammary Artery Grafts Be Used For mentioning

confidence: 99%

Almanac 2012—adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology

Bridgewater¹

2012

Heart

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“…2,3 Several studies have found that isolated troponin rise after CABG, measured with contemporary assays, independently predicts adverse outcomes. [3][4][5][6][7] High-sensitivity troponin assays have recently been developed, 8 being more sensitive than contemporary assays at detecting lower troponin levels. 1,9 The properties and utility of these assay may be different after CABG, and…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Wang

Stewart

Ramanathan

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Aims: Criteria for diagnosing myocardial infarction (MI) after coronary artery bypass grafting (CABG) are controversial. Uncertainties remain around the optimal threshold for biomarker elevation and the need for associated criteria. There are no studies of high-sensitivity troponin (hs-TnT) after CABG. We assessed whether using hs-TnT to define MI after CABG was associated with 30-day and medium-term mortality and evaluated the utility of adding to the troponin criteria new Q-waves or imaging evidence of new wall motion abnormality as suggested in the Universal Definition of MI. Methods: Isolated CABG was performed in 818 patients from July 2010 to June 2012 and hs-TnT was measured 12-24 hours after CABG. Patients with rising baseline or missing troponins (n=258) were excluded. Thresholds of 140 ng/l (10-times 99th percentile upper reference limit) and 500 ng/l (10-times coefficient of variation of 10% for fourthgeneration troponin T applied to hs-TnT) were prespecified. Results: Mean follow up was 1.8±0.6 years. On multivariate analyses, isolated hs-TnT rise >140 ng/l (n=360) or >500 ng/l (n=162) were not associated with mortality. Additional ECG and/or echocardiographic criteria plus hs-TnT >140 ng/l was associated with 30-day mortality (hazard ratio, HR, 4.92, 95% CI 1.34-18.1; p=0.017) and medium-term mortality (HR 3.44, p=0.030), whereas ECG and/or echocardiographic abnormalities with hs-TnT >500 ng/l was not (p=0.281 and p=0.123 for 30-day and medium-term mortality, respectively). Conclusions: A definition for MI following CABG using hs-TnT with a cut point of 10-times 99th percentile upper reference limit and ECG and/or echocardiographic criteria predicts 30-day and medium-term mortality. These findings validate the Third Universal Definition of type 5 MI.

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“…This can be the result of many factors, including contact of blood with the bypass circuit, myocardial ischemia during bypass, aortic cross clamping, and reperfusion injury [36][37][38][39] [46][47][48]. Identifying CABG-related infarction using conventional ECG and biochemical methods, however, can be difficult.…”

Section: Surgical Interventionsmentioning

confidence: 99%

Iatrogenic Coronary Microvascular Dysfunction

Crea

Lanza

Camici

2013

Coronary Microvascular Dysfunction

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Percutaneous coronary revascularization has become a widely used and effective treatment for CAD. Severe acute complications are rare, but a mild and asymptomatic release of biochemical markers of myocardial necrosis is frequently observed after otherwise technically successful interventions. Both impairment of flow in coronary side branches following stent deployment and distal embolization of atheromatous material contribute to myocardial necrosis during PCI. Occlusion of small side branches is associated with necrosis in small myocardial regions adjacent to the territory supplied by the stented coronary artery. Distal necrosis in the dependent vascular territory occurs, instead, when atheromatous plaque is embolized during the percutaneous procedure ( Fig. 7.1) [1,2]. Distal embolization is more extensive following PCI in saphenous vein grafts than in native coronary arteries and is more frequent following PCI in unstable patients than in stable patients ( Fig. 7.2) [3,4]. Notably, Prati et al. found that in unstable patients a considerable amount of the lumen enlargement obtained after stenting was attributable to plaque reduction associated with distal embolization and a proportional rise of myocardial necrosis markers (Fig. 7.3) [5].Based on these and other observations, the last version of the universal definition of myocardial infarction suggests that, by arbitrary convention, myocardial infarction related to PCI (type 4) should be diagnosed when troponin values [5 times the upper normal limit during the first 48 h after the procedure are detected, occurring from a normal baseline troponin value, together with (1) evidence of prolonged ischemia (C20 min) as demonstrated by prolonged chest pain, or (2) ischemic ST changes or new pathological Q waves, or (3) angiographic evidence of a flow-limiting complication, such as loss of patency of a side branch, persistent slow-flow or no-reflow, embolization, or (4) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality [6].The clinical relevance of distal embolization during PCI is considerable. In a recent comprehensive meta-analysis, Testa et al. have assessed the occurrence and the prognostic impact of Tn elevation in patients with normal baseline levels

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Utility of cardiac biomarkers for the diagnosis of type V myocardial infarction after coronary artery bypass grafting: insights from serial cardiac MRI

Cited by 56 publications

References 27 publications

Almanac 2012—adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology

Almanac 2012—adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology

Diagnosis of MI after CABG with high-sensitivity troponin T and new ECG or echocardiogram changes: relationship with mortality and validation of the Universal Definition of MI

Iatrogenic Coronary Microvascular Dysfunction

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