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Ann Thorac Surg 2011;92:2046-2053. doi:10.1016/j.athoracsur.2011.05.019
© 2011 The Society of Thoracic Surgeons
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Original Articles: Adult Cardiac

Early Diagnosis of Perioperative Myocardial Infarction After Coronary Bypass Grafting: A Study Using Biomarkers and Cardiac Magnetic Resonance Imaging

Chris C.S. Lim, MBBSa, Florim Cuculi, MDa, William J. van Gaal, MBBS, MDb,c, Luca Testa, MDa,d, Jayanth R. Arnold, MDa, Theodoros Karamitsos, MDe, Jane M. Francis, DCCR, DNMe, Janet E. Digby, PhDa, Charalambos Antoniades, MD, PhDa, Rajesh K. Kharbanda, PhDa, Stefan Neubauer, MDe, Stephen Westaby, PhD, FACCa, Adrian P. Banning, MDa,*

a Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom
b Department of Cardiology, The Northern Hospital, Melbourne, Victoria, Australia
c Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
d Department of Interventional Cardiology, Sant'Ambrogio Clinical Institute, Milan, Italy
e University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom

Accepted for publication May 9, 2011.

* Address correspondence to Dr Banning, Oxford Heart Centre, The John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK (Email: adrian.banning{at}orh.nhs.uk).

Background: Myocardial injury related to coronary artery bypass grafting (CABG) is poorly characterized, and understanding the characteristic release of biomarkers associated with revascularization injury might provide novel therapeutic opportunities. This study characterized early changes in biomarkers after revascularization injury during on-pump CABG.

Methods: This prospective study comprised 28 patients undergoing on-pump CABG and late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) who underwent measurements of cardiac troponin I (cTnI), creatine kinase-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, interleukin 6, tumor necrosis factor-α, matrix metalloproteinase 9a, monocyte chemotactic protein-1, plasminogen activator inhibitor-1a) at baseline, at 1, 6, 12, and 24 hours, and at 1 week (inflammatory markers only) post-CABG. Biomarker results at 1 hour were studied for a relationship to new myocardial infarction as defined by CMRI-LGE, and the diagnostic utility of combining positive biomarkers was assessed.

Results: All patients had an uneventful recovery, but 9 showed a new myocardial infarction demonstrated by new areas of hyperenhancement on CMR. Peak cTnI at 24 hours ({rho} = 0.66, p < 0.001) and CK-MB ({rho} = 0.66, p < 0.001) correlated with the amount of new LGE. At 1 hour, 3 biomarkers—cTnI, interleukin 6, and tumor necrosis factor-α—were significantly elevated in patients with vs those without new LGE. Receiver operating curve analysis showed cTnI was the most accurate at detecting new LGE at 1 hour: a cutoff of cTnI exceeding 5 μg/L at 1 hour had 67% sensitivity and 79% specificity for detecting new LGE.

Conclusions: Unexpected CABG-related myocardial injury occurs in a significant proportion of patients. A cTnI test at 1 hour after CABG could potentially differentiate patients with significant revascularization injury.


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