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Clinical Significance of Creatine Kinase MB mass and Cardiac Troponin I as a Marker of Perioperative Myocardial Infarction After Coronary Artery Bypass Grafting  

이재진 (한림대학교 의과대학 강동성심병원 흉부외과)
김응중 (한림대학교 의과대학 강동성심병원 흉부외과)
이원용 (한림대학교 의과대학 한림대학교성심병원 흉부외과)
신윤철 (한림대학교 의과대학 강동성심병원 흉부외과)
지현근 (한림대학교 의과대학 강동성심병원 흉부외과)
Publication Information
Journal of Chest Surgery / v.35, no.1, 2002 , pp. 27-35 More about this Journal
Abstract
Background: A perioperative myocardial infarction(PMI) is one of the major complications after CABG. Among diagnostic methods of PMI, CK-MB activity assays have been increasingly replaced by CK-MB mass assays, which have more sensitive, simple measurement. Also, new cardiac-specific and -sensitive marker, cardiac troponin I(cTnl), has been shown to be a marker of myocardial infarction. We report our evaluation of clinical significance of CK-MB mass and cTnl as a marker of PMI after CABG. Material and Method: We studied 32 patients who underwent CABG at Kangdong Sacred Hospital between April 2000 and April 2001. Postoperative serum CK-MB activity level, serum CK-MB mass, cTnl, electrocardiogram, echocardiogram, and clinical data were recorded prospectively The diagnosis of PMI was defined as positive 2 among 3 or all of the following , by a new Q wave on the electrocardiogram, by serum CK-MB activity higher than 200 lU/L within 72 hours after operation, and by new regional wall motion abnormality on the echocardiogram. Result: After CABG, 3 patients had sustained a PMI according to current diagnostic criteria. As serum CK-MB activity time course, a level of CK-MB activity 12 hours after CABG had very linear correlated significance with serum CK-MB mass 24hours(R=0.946) and cTnl 48 hours(R=0.933) after CABG(p=0.000). As we used a receiver operating characteristics curve(ROC curve) for a diagnostic cutoff value in patients with PMI, serum CK-MB mass levels higher than 30.05 ug/L 24 hours after CABG detected the presence of PMI with an area under the ROC curve of 1.0, a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100%. Also serum cTnl levels higher than 17.15 ug/L 48 hours after CABG detected the presence of PMI with an area under the ROC curve of 0.98, a sensitivity of 100%, a specificity of 96.6%, a positive preclictive value of 75%, and a negative predictive value of 100% Conclusion: We concluded that both the measurement of CK-MB mass and cTnl are the easier, accurate methods as a diagnostic marker of PMT after CABG, also as a proposal of diagnostic cutoff value enables to an early detection of PMI. However, a 1arger number of patient will be needed because of statistic limitation that a small number of participating patients, a small number of PMI.
Keywords
Myocardial infarction, CK-MB mass, cTnI; Candiac eujyue; PMI; cTnI;
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Times Cited By KSCI : 1  (Citation Analysis)
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1 Increased creatine kinase MB in the absence of acute myocardial infarction /
[ Chan KM;Ladenson JH;Pierce CF;Jaffe AS ] / Clin Chem
2 Changes in serum creatine kinase and lactate dephdrogenase caused by acute perioperative myocardial infarction and by transatrial cardiac surgical procedures /
[ Graeber GM;Shawl FA;Head HD ] / J Thorac Cardiovasc Surg
3 Early detection of acute myocardial infarction by measurement of mass concentration of creatine kinase-MB /
[ Mair J;Artner DE;Dienstl A(et al.) ] / Am J Cardiol   DOI   ScienceOn
4 관상동맥 우회술 500례의 임상적 고찰 /
[ 신윤철;김기봉;안혁(등) ] / 대흉외지   과학기술학회마을
5 Interpretation of changes in the activity of creatini kinase MB isoenzyme in serum after coronary artery bypass grafting /
[ Farah SY;Moss DW;Ribeiro P;Oakley CM;Sapsford RN ] / Clin Clim Acta   DOI
6 Non-invasive assessment of perioperative myocardial cell damage by circulating cardiac Troponin T. /
[ Katus HA;Schoeppenthau M;Tanzeem A ] / Br Heart J   DOI   ScienceOn
7 Use of cardiac Troponin I as a marker of Perioperative Myocardial Ischemia /
[ Etievent JP;Chocron S;Toubin G(et al.) ] / Ann Thorac Surg   DOI   ScienceOn
8 Use of cardiac troponin I to diagnose perioperative myocardial infarction in coronary artery bypass grafting /
[ Mair J;Larue C;Balogh D;Calzolari C;Puschendorf B ] / Clin Chem
9 Myocardial preservation during coronary surgery with and without cardiopulmonary bypass /
[ Penttila HJ;Lepojarvi MV;Kiviluoma KT;Kaukoranta PK ] / Ann Thorac Surg   DOI   ScienceOn
10 Troponin levels in patients with myocardial infarction after coronary artery bypass grafting /
[ Carrier M;Pellerin M;Perrault LP;Solymoss BC;Pelletier LC ] / Ann Thorac Surg   DOI   ScienceOn
11 The predictive value of serum enzymes for perioperative myocardial infarction after cardiac operations. An autopsy study /
[ Van Lente F;Martin A;Ratliff NB;Kazmierczak SC;Loop FD ] / J Thorac Cardiovasc Surg
12 Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery /
[ Chaitman BR;Alderman EL;Sheffield LT(et al.) ] / Circulation   DOI   ScienceOn
13 Cardiac troponin I in diagnosis of perioperative myocardial infarction after cardiac surgery /
[ Alyanakian MA;Dehoux M;Chatel D;Seguret C ] / J Cardiothorac Vasc Anesth   DOI   ScienceOn
14 Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosn light chain levels in suspected myocardial infarction /
[ Ravkilde J;Nissen H;Horder M;Thygesen K ] / J Am Coll Cardiol   DOI   ScienceOn
15 Cardiac troponin I and troponin T:Are enzymes still relevant as cardiac markers? /
[ Mair J ] / Clin Clim Acta   DOI   ScienceOn
16 Progress in myocardial damage detection:New biochemical markers for clinicians /
[ Mair J ] / Critical Review in Clinical Lab Sci   DOI   ScienceOn
17 Serum levels of cardiac troponin I and troponi T in estimating myocardial infarct size soon after reperfusion /
[ Tanaka H;Abe T;Yamashita T(et al.) ] / Coronary Artery Dis   DOI   ScienceOn
18 Human cardiac troponin I-detectability after myocardial infarction and servere skeletal muscle damage /
[ Thome-Kromer B;Michel G ] / Clin Chem
19 Clinical significance of perioperative Q-wave myocardial infarction:the Emory Angioplasty versus Surgery Trial /
[ Hodakowski GT;Craver JM;Jones EL;King SB Ⅲ;Guyton RA ] / J Thorac Cardiovasc Surg   DOI   ScienceOn
20 Perioperative myocardial infarction after coronary artery bypass surgery. Clinical significance and approach to risk stratification /
[ Force T;Hibberd P;Weeks G(et al.) ] / Circulation   DOI   ScienceOn
21 Perioperative myocardial infarction /
[ Tuman KJ ] / Semin Thorac Cardiovasc Surg
22 Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass /
[ Czerny M;Baumer H;Kilo J;Lassnigg A;Hamwi A;Vukovich T ] / Eur J Cardiothorac Surg   DOI   ScienceOn