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Perioperative creatine phosphokinase (CPK) and troponin I trends after elective hip surgery
George Mouzopoulos1, Christos Kouvaris, Dimitrios Antonopoulos
1Orthopaedic Department of Evangelismos Hospital, Athens, Greece. gmouzop@yahoo.gr
Insights
Troponin I is more specific than creatine kinase-MB (CK-MB) for detecting myocardial infarction (MI) after hip surgery. While both markers can elevate, troponin I only rises with actual MI, unlike CK-MB which can falsely elevate.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Clinical Biochemistry
Background:
- Perioperative myocardial infarction (MI) is a significant risk factor for cardiac complications following hip surgery.
- Limitations exist with creatine kinase cardiac muscle isoenzyme (CK-MB) for perioperative MI detection.
- Troponin I offers high specificity for diagnosing cardiac events.
Purpose of the Study:
- To compare the diagnostic effectiveness of troponin I versus CK-MB in detecting perioperative MI after hip surgery.
- To investigate the frequency of MI detection using troponin I compared to CK-MB in this patient cohort.
Main Methods:
- A prospective study involving 90 patients with coronary artery disease risk factors undergoing hip surgery.
- Serum levels of creatine phosphokinase (CPK), CK-MB, and troponin I were measured for 5 days postoperatively.
- Measurements were taken after hemiarthroplasty, total hip arthroplasty, and hip intramedullary nailing procedures.
Main Results:
- Elevated CPK and CK-MB levels were observed post-surgery, peaking on the first postoperative day, with higher levels after total hip arthroplasty.
- A significant rate of false-elevated CK-MB index (>6%) was noted in 43.3% of patients without MI.
- Troponin I elevation (>3.1 ng/mL) occurred exclusively in patients who experienced postoperative MI; all MI patients had elevated troponin I and CK-MB.
Conclusions:
- Troponin I and CK-MB index demonstrate similar sensitivity in detecting MI post-hip surgery.
- Troponin I exhibits superior specificity compared to CK-MB index for diagnosing MI in the context of hip surgery.
- False elevations in CK-MB may be linked to implant size, reaming, and heating effects, rather than solely direct muscle damage.
Background:
Perioperative myocardial infarction (MI) is an important risk factor for cardiac morbidity and mortality after hip surgery. On the basis of the limitations of creatine kinase cardiac muscle isoenzyme (CK-MB) in the perioperative setting, and the high specificity of troponin I, we hypothesized that troponin I would be effective at detecting perioperative MI more frequently than CK-MB would be, after hip surgery.
Methods:
A prospective study of the serum levels of creatine phosphokinase (CPK), its isoenzyme CK-MB, and troponin I, in 90 patients with risk factors for coronary artery disease, undergoing hip surgery is reported. We measured these cardiac markers in the postoperative period for 5 days, after hemiarthroplasty, total hip arthroplasty, and hip intramedullary nailing.
Results:
We found increased levels of creatine phosphokinase and CK-MB, after all the types of operation, with maximum levels reached on the first postoperative day and the levels were more pronounced after total hip arthroplasty. False-elevated CK-MB index >6% without MI was evidenced in 43.3% of patients. Troponin I levels were elevated >3.1 ng/mL only in the patients who suffered MI postoperatively. All the patients who suffered MI had both CK-MB index and troponin I levels elevated. Also, we found high correlation between maximum CK-MB levels and size of implants, which means that reaming and its heating effect may be responsible for false-elevated CK-MB levels, except direct muscle damage caused by surgical incision.
Conclusion:
CK-MB index and troponin I have the same sensitivity, but troponin I is more specific than CK-MB index in detecting MI after hip surgery.
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