HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Francesco Onorati Antonio Esposito Attilio Renzulli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Onorati, F. Articles by Renzulli, A. Search for Related Content PubMed PubMed Citation Articles by Onorati, F. Articles by Renzulli, A. Related Collections Myocardial protection

Ann Thorac Surg 2007;83:1016-1023
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Troponin I and Lactate From Coronary Sinus Predict Cardiac Complications After Myocardial Revascularization

^a Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy
^b Anesthesiology and Critical Care Unit, Magna Graecia University, Catanzaro, Italy

Accepted for publication October 23, 2006.

^_* Address correspondence to Dr Onorati, Viale dei Pini, 28, Napoli 80131, Italy (Email: frankono{at}libero.it).

Background: Postoperative troponin I and lactate elevation are related to cardiac complications after myocardial revascularization. We sought to evaluate earlier predictive value for acute myocardial infarction (AMI) and myocardial damage of troponin I and lactate after myocardial revascularization.

Methods: In all, 183 consecutive isolated myocardial revascularizations were prospectively enrolled in the study. Troponin I and lactate were sampled preoperatively and intraoperatively from the coronary sinus, and at 12, 24, 48, and 72 hours. Hospital outcome was recorded. Receiver operating curves for coronary sinus troponin I and lactate were constructed to differentiate patients with or without AMI and myocardial damage.

Results: Acute myocardial infarction developed in 6 patients (3.2%), with higher troponin I and lactate at all time points (p < 0.05), longer intubation time (p = 0.003), intensive care unit stay (p = 0.001), hospital stay (p = 0.001), higher atrial fibrillation (p = 0.001), and worse ventricular function (p = 0.001). Myocardial damage developed in 6 patients (3.2%), showing higher troponin I at all time points (p < 0.001), higher intraoperative lactate (p = 0.04), longer intubation time (p = 0.005), and intensive care unit stay (p = 0.03). Receiver operating characteristic curves demonstrated coronary sinus troponin I greater than 0.94 µg/L (area under the curve [AUC] 0.820 ± 0.075; sensitivity 90.0%, specificity 68.9%) as a better discriminator between patients with or without AMI than lactate level greater than 2.85 mmol/L (AUC 0.686 ± 0.090; sensitivity 80.0%; specificity 72.9%); troponin I greater than 0.65 µg/L was a better discriminator between patients with or without myocardial damage (AUC 0.834 ± 0.061; sensitivity 93.8%, specificity 71.5%), than lactate greater than 2.05mmol/L (AUC 0.627 ± 0.067; sensitivity 87.5%; specificity 70.7%).

Conclusions: Coronary sinus troponin I and lactate are predictive for cardiac complications after myocardial revascularization. Intraoperative biochemical assays should be routinely performed to establish preventative strategies to reduce further myocardial damage.

This article has been cited by other articles:

				J. C. Leal, O. Petrucci, M. F. Godoy, and D. M. Braile Perioperative serum troponin I levels are associated with higher risk for atrial fibrillation in patients undergoing coronary artery bypass graft surgery Interact CardioVasc Thorac Surg, January 1, 2012; 14(1): 22 - 25. [Abstract] [Full Text] [PDF]

				H. Gasparovic, I. Burcar, T. Kopjar, J. Vojkovic, R. Gabelica, B. Biocina, and I. Jelic NT-pro-BNP, but not C-reactive protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery Eur J Cardiothorac Surg, January 1, 2010; 37(1): 100 - 105. [Abstract] [Full Text] [PDF]

				F. Onorati, A. S. Rubino, D. Marturano, E. Pasceri, G. Santarpino, S. Zinzi, G. Mascaro, and A. Renzulli Midterm clinical and echocardiographic results and predictors of mitral regurgitation recurrence following restrictive annuloplasty for ischemic cardiomyopathy J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 654 - 662. [Abstract] [Full Text] [PDF]

				G. Santarpino, F. Onorati, A. S. Rubino, K. Abdalla, S. Caroleo, E. Santangelo, and A. Renzulli Preoperative Intraaortic Balloon Pumping Improves Outcomes for High-Risk Patients in Routine Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., February 1, 2009; 87(2): 481 - 488. [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]