PMID- 21962261
OWN - NLM
STAT- MEDLINE
DCOM- 20120117
LR  - 20220408
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 92
IP  - 6
DP  - 2011 Dec
TI  - Early diagnosis of perioperative myocardial infarction after coronary bypass 
      grafting: a study using biomarkers and cardiac magnetic resonance imaging.
PG  - 2046-53
LID - 10.1016/j.athoracsur.2011.05.019 [doi]
AB  - 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-alpha, 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-alpha--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 mug/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.
CI  - Copyright (c) 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Lim, Chris C S
AU  - Lim CC
AD  - Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom.
FAU - Cuculi, Florim
AU  - Cuculi F
FAU - van Gaal, William J
AU  - van Gaal WJ
FAU - Testa, Luca
AU  - Testa L
FAU - Arnold, Jayanth R
AU  - Arnold JR
FAU - Karamitsos, Theodoros
AU  - Karamitsos T
FAU - Francis, Jane M
AU  - Francis JM
FAU - Digby, Janet E
AU  - Digby JE
FAU - Antoniades, Charalambos
AU  - Antoniades C
FAU - Kharbanda, Rajesh K
AU  - Kharbanda RK
FAU - Neubauer, Stefan
AU  - Neubauer S
FAU - Westaby, Stephen
AU  - Westaby S
FAU - Banning, Adrian P
AU  - Banning AP
LA  - eng
GR  - 090532/WT_/Wellcome Trust/United Kingdom
GR  - BHF_/British Heart Foundation/United Kingdom
GR  - MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111001
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Biomarkers)
SB  - IM
CIN - Ann Thorac Surg. 2011 Dec;92(6):2053. PMID: 22115217
CIN - Ann Thorac Surg. 2012 Sep;94(3):1035-6; author reply 1036. PMID: 22916768
MH  - Aged
MH  - Biomarkers/blood
MH  - Coronary Artery Bypass/*adverse effects
MH  - Early Diagnosis
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*diagnosis
MH  - Perioperative Period
MH  - Prospective Studies
MH  - ROC Curve
EDAT- 2011/10/04 06:00
MHDA- 2012/01/18 06:00
CRDT- 2011/10/04 06:00
PHST- 2011/03/10 00:00 [received]
PHST- 2011/05/02 00:00 [revised]
PHST- 2011/05/09 00:00 [accepted]
PHST- 2011/10/04 06:00 [entrez]
PHST- 2011/10/04 06:00 [pubmed]
PHST- 2012/01/18 06:00 [medline]
AID - S0003-4975(11)01187-8 [pii]
AID - 10.1016/j.athoracsur.2011.05.019 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2011 Dec;92(6):2046-53. doi: 10.1016/j.athoracsur.2011.05.019. 
      Epub 2011 Oct 1.