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Published on: September 15, 2023
Cardiac biomarker release after CABG with different surgical techniques
Giuseppe Crescenzi1, Valeria Cedrati, Giovanni Landoni
1Department of Cardiovascular Anesthesia, IRCCS San Raffele Hospital, Milano, Italy.
Insights
Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) results in higher cardiac troponin I release compared to off-pump CABG. Off-pump CABG (OPCABG) is less invasive for the heart regarding myocardial marker release.
Area of Science:
- Cardiovascular Surgery
- Cardiac Biomarkers
- Myocardial Injury
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- The use of cardiopulmonary bypass (CPB) during CABG may impact myocardial injury.
- Cardiac biomarkers like troponin I and CK-MB are indicators of myocardial damage.
Purpose of the Study:
- To compare the release of cardiac biomarkers (troponin I, CK-MB) in patients undergoing CABG with or without CPB.
- To identify predictors of peak cardiac troponin release after CABG.
Main Methods:
- Prospective study conducted at a university tertiary hospital.
- Included 65 consecutive patients undergoing elective CABG for multi-vessel disease.
- Measured cardiac biomarkers pre-surgery, upon ICU arrival, and 4 and 18 hours post-procedure.
Main Results:
- On-pump CABG patients exhibited significantly higher cardiac biomarker release than off-pump CABG patients at all time points.
- Cardiopulmonary bypass (CPB), number of distal grafts, and hypertension treatment were independent predictors of peak troponin release.
- CPB was strongly associated with increased troponin release (p < 0.0001).
Conclusions:
- Cardiac troponin I release after multi-vessel CABG is technique-dependent.
- Consideration of different normal ranges for troponin I based on surgical technique is warranted.
- Off-pump coronary artery bypass grafting (OPCABG) appears to be minimally invasive concerning myocardial marker release.
Objective:
To investigate the release of cardiac biomarkers (troponin I and CK-MB) in patients undergoing coronary artery bypass graft (CABG) with or without cardiopulmonary bypass (CPB).
Design:
Prospective study.
Setting:
University tertiary hospital.
Participants:
Sixty-five consecutive patients undergoing coronary artery bypass grafting (>or=2 vessel disease, ejection fraction >or=0.35%, elective procedure).
Interventions:
Cardiac biomarkers were measured before surgery, at intensive care unit arrival, 4 and 18 hours after the end of the procedure.
Measurements And Main Results:
Cardiac biomarker release was higher in on-pump than in off-pump patients at every time point. On multivariate analysis, CPB (p < 0.0001), number of distal grafts (p = 0.005), and hypertension treatment (p = 0.03) were the only independent predictors of peak cardiac troponin release.
Conclusions:
Cardiac troponin I release after multivessel CABG is associated with the technique. Different values for the normal range should be considered. OPCABG is minimally invasive for the heart as far as myocardial marker release is concerned.
