Related Experiment Videos
Do we still need CK-MB in coronary artery bypass grafting surgery?
D Bimmel1, B Patermann, T Schlosser
1Department of Cardiac Surgery, University of Bonn, Bonn, Germany. dieter.bimmel@ukb.uni-bonn.de
Insights
Cardiac Troponin I (cTnI) is a superior biomarker for predicting outcomes after coronary artery bypass grafting (CABG) surgery compared to CK-MB. This study highlights cTnI
Area of Science:
- Cardiology
- Biomarkers
- Cardiac Surgery
Background:
- Early prediction of outcomes in patients undergoing coronary artery bypass grafting (CABG) surgery is crucial.
- Cardiac Troponin I (cTnI) and CK-MB are commonly used biomarkers, but their comparative efficacy in this context requires clarification.
Purpose of the Study:
- To evaluate the role of cardiac Troponin I (cTnI) and CK-MB for early prediction of outcomes in patients undergoing CABG surgery.
- To compare the diagnostic accuracy of cTnI and CK-MB in identifying perioperative myocardial ischemia (PMI).
Main Methods:
- 134 consecutive patients undergoing CABG surgery were analyzed for cTnI concentration and CK-MB activity.
- Continuous monitoring of ECG, hemodynamic parameters, and inotropic support was performed.
- Patients were stratified into groups based on the presence and severity of ischemia (uneventful, hemodynamic stability, or requiring IABP).
Main Results:
- Elevated cTnI and CK-MB levels were observed post-surgery in all patients.
- Five hours after cardiopulmonary bypass (CPB) cessation, significantly lower cTnI levels were found in patients with an uneventful course compared to those with ischemia (p=0.035 and p=0.023).
- cTnI demonstrated higher sensitivity (99%) and specificity (97%) than CK-MB (90%/30%), with a better positive predictive value (86% vs. 33%) for predicting outcomes.
Conclusions:
- Cardiac Troponin I (cTnI) is a specific and sensitive marker for evaluating perioperative myocardial ischemia (PMI) in CABG patients.
- CK-MB activity provides no additional clinical information beyond cTnI.
- cTnI should be the preferred biomarker for outcome prediction in CABG surgery.
Aim:
The aim of this study was to evaluate the role of cardiac Troponin I (cTnI) and CK-MB for early prediction of outcome of patients undergoing coronary artery bypass grafting (CABG) surgery.
Methods:
In 134 consecutive patients undergoing CABG-surgery blood samples were analyzed for cTnI concentration and CK-MB activity. ECG, hemodynamic parameters and the need for inotropic support, were continuously registered. Patients were divided into group A (uneventful course), group B (ischemia by ECG, hemodynamic stability) and group C (ischemia by ECG and IABP).
Results:
After removal of X-clamp an increase cTnI and CK-MB was observed in all patients. Five hrs after stop of CPB group A (8.3+/-4.2 microg/L) had lower cTnI values compared to group B (14.8+/-5.3 microg/L) (p=0.035) and C (54+/-22.8 microg/L) (p=0.023). The cut off value was 14.8 microg/L. Sensitivity and specificity (99%/97%) was higher for cTnI than for CK-MB (90%/30%). The positive predictive value of outcome was better for cTnI (86%) than for CK-MB (33%).
Conclusion:
CTnI is a specific and sensitive marker for evaluation of perioperative myocardial ischemia (PMI). Additional determination of CK-MB activity does not provide further clinical information. CTnI should be the marker of first choice in CABG surgery.