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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.
Journal of Cardiothoracic and Vascular Anesthesia
|February 20, 2004
Summary
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.