| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2005;79:837-845
© 2005 The Society of Thoracic Surgeons
a Cardiac Surgery Unit, University Magna Graecia, Catanzaro
b Department of Cardiothoracic Surgery, Second University of Naples, Naples, Italy
Accepted for publication July 23, 2004.
* Address reprint requests to Dr Onorati, Viale dei Pini, 28, 80131 Napoli, Italy (E-mail: frankono{at}libero.it).
BACKGROUND: Myocardial infarction remains a devastating complication after coronary revascularization. Although electrocardiography (ECG) and echocardiography suggest transmural infarction, myocardial damage and the quality of myocardial protection are not recognized unless troponin I (TnI) is assessed. Determinants and prognosis of TnI elevation after coronary artery bypass grafting (CABG) were evaluated.
METHODS: Data of 776 consecutive patients undergoing CABG between January 2002 and January 2004 were prospectively exposed to univariate and multivariate analysis. We evaluated the prognosis of patients with all the ECG, echocardiographic, and biochemical criteria for acute myocardial infarction and that of patients with only TnI elevation. Twelve-month follow-up survival and freedom from cardiac events (FCE) were accomplished.
RESULTS: Troponin I greater than 3.1 µg/L at 12 hours was detected in 6.9% of the population, and correlated with lower in-hospital (p < 0.001) and follow-up survival (p = 0.00001), and lower FCE (p = 0.0009). Twenty-one (38.8%) of these fulfilled ECG-echocardiographic criteria (p = 0.05), demonstrating higher TnI values at 12 (p = 0.001), 24 (p = 0.01), 48 (p = 0.01), and 72 (p = 0.04) hours, prolonged ventilation time (p = 0.001), higher in hospital mortality (p = 0.003), lower follow-up survival (p = 0.023), and lower FCE (p = 0.0084). A EuroSCORE greater than 6, ongoing unstable angina, aortic cross-clamp time greater than 90 minutes, cardiopulmonary bypass time greater than 180 minutes, incomplete revascularization, and intraoperative intraaortic balloon pump were independent predictors of myocardial damage (MD) at multivariate analysis. Combined antegrade and retrograde cardioplegia and postoperative enoximone infusion were associated with a lower TnI elevation.
CONCLUSIONS: Troponin I greater than 3.1 µg/L at 12 hours defines perioperative MD. Associated ECG-echocardiographic criteria indicate acute myocardial infarction and anticipate a worse outcome. Identification of predictors for MD is important to develop preventative strategies, as antegrade plus retrograde cardioplegia and enoximone infusion.
This article has been cited by other articles:
|
|
 |
|
  L. De Santo, G. Romano, A. Della Corte, V. de Simone, F. Grimaldi, M. Cotrufo, and M. de Feo Preoperative anemia in patients undergoing coronary artery bypass grafting predicts acute kidney injury J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 965 - 970. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Mohammed, A. K. Agnihotri, R. R.J. van Kimmenade, A. Martinez-Rumayor, S. M. Green, R. Quiroz, and J. L. Januzzi Jr Prospective, Comprehensive Assessment of Cardiac Troponin T Testing After Coronary Artery Bypass Graft Surgery Circulation, September 8, 2009; 120(10): 843 - 850. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Petaja, M. Salmenpera, K. Pulkki, and V. Pettila Biochemical Injury Markers and Mortality After Coronary Artery Bypass Grafting: A Systematic Review. Ann. Thorac. Surg., June 1, 2009; 87(6): 1981 - 1992.e3. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Rubino, F. Onorati, G. Santarpino, K. Abdalla, S. Caroleo, E. Santangelo, and A. Renzulli Early intra-aortic balloon pumping following perioperative myocardial injury improves hospital and mid-term prognosis Interactive CardioVascular and Thoracic Surgery, March 1, 2009; 8(3): 310 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Romagnoli, F Burzotta, C Trani, M Siviglia, G G L Biondi-Zoccai, G Niccoli, A M Leone, I Porto, M A Mazzari, R Mongiardo, et al. EuroSCORE as predictor of in-hospital mortality after percutaneous coronary intervention Heart, January 1, 2009; 95(1): 43 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. A. Mannacio, D. Iorio, V. De Amicis, F. Di Lello, and F. Musumeci Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery: a randomized trial. J. Thorac. Cardiovasc. Surg., December 1, 2008; 136(6): 1541 - 1548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Alamanni, L. Dainese, M. Naliato, S. Gregu, M. Agrifoglio, G. L. Polvani, P. Biglioli, A. Parolari, and for the Monzino OPCAB Investigators On- and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 118 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Durham and J. P. Gold Late Complications of Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 535 - 548. [Full Text]
|
|
|
|
 |
|
 NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Dyke, L. K. Jennings, G. Maier, C. Andreou, R. Daly, and M. R. Tamberella III Preoperative Platelet Inhibition With Eptifibatide During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2007; 12(1): 54 - 60. [Abstract] [PDF]
|
|
|
|
|
|
F. Onorati, L. Cristodoro, S. Caroleo, A. Esposito, B. Amantea, E. Santangelo, and A. Renzulli Troponin I and Lactate From Coronary Sinus Predict Cardiac Complications After Myocardial Revascularization Ann. Thorac. Surg., March 1, 2007; 83(3): 1016 - 1023. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Patti, M. Chello, D. Candura, V. Pasceri, A. D'Ambrosio, E. Covino, and G. Di Sciascio Randomized Trial of Atorvastatin for Reduction of Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of MYocardial Dysrhythmia After cardiac surgery) Study Circulation, October 3, 2006; 114(14): 1455 - 1461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Smith, M. Carrier, J. C. Chen, A. Haverich, J. H. Levy, P. Menasche, S. K. Shernan, F. Van de Werf, P. X. Adams, T. G. Todaro, et al. Effect of pexelizumab in coronary artery bypass graft surgery with extended aortic cross-clamp time. Ann. Thorac. Surg., September 1, 2006; 82(3): 781 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Onorati, L. Cristodoro, M. Bilotta, B. Impiombato, F. Pezzo, P. Mastroroberto, A. di Virgilio, and A. Renzulli Intraaortic balloon pumping during cardioplegic arrest preserves lung function in patients with chronic obstructive pulmonary disease. Ann. Thorac. Surg., July 1, 2006; 82(1): 35 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Thielmann, P. Massoudy, B. R. Jaeger, M. Neuhauser, G. Marggraf, S. Sack, R. Erbel, and H. Jakob Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 117 - 125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Al-Ruzzeh, S. George, M. Bustami, J. Wray, C. Ilsley, T. Athanasiou, and M. Amrani Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial BMJ, June 10, 2006; 332(7554): 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. P. Siegenthaler Antegrade administration of cardioplegia MMCTS, June 28, 2005; 2005(0628): 695. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
