Key result
On-pump CABG without CMR-confirmed MI massively elevates cTnI in ~96% of patients, far exceeding CK-MB.
Observational (n=54)
Single-blind
No
Troponin I is frequently elevated >10 times the 99th percentile after on-pump CABG without CMR evidence of myocardial infarction, suggesting CK-MB may be more accurate for excluding peri-procedural MI or that higher troponin cutoffs are needed.
Troponin I >10× ULN after uncomplicated on-pump CABG is common; leaves open optimal biomarker thresholds for peri-procedural MI.
BACKGROUND: The diagnosis of peri-procedural myocardial infarction is complex, especially after the emergence of high-sensitivity markers of myocardial necrosis. METHODS: In this study, patients with normal baseline cardiac biomarkers and formal indication for elective on-pump coronary bypass surgery were evaluated. Electrocardiograms, cardiac biomarkers, and cardiac magnetic resonance imaging with late gadolinium enhancement were performed before and after procedures. Myocardial infarction was defined as more than ten times the upper reference limit of the 99th percentile for troponin I and for creatine kinase isoform (CK-MB) and by the findings of new late gadolinium enhancement on cardiac magnetic resonance. We assessed the release of cardiac biomarkers in patients with no evidence of myocardial infarction on cardiac magnetic resonance. RESULTS: Of 75 patients referred for on-pump coronary bypass surgery, 54 (100%) did not have evidence of myocardial infarction on cardiac magnetic resonance. However, all had a peak troponin I above the 99th percentile; 52 (96%) had an elevation 10 times higher than the 99th percentile. Regarding CK-MB, 54 (100%) patients had a peak CK-MB above the 99th percentile limit, and only 13 (24%) had an elevation greater than 10 times the 99th percentile. The median value of troponin I peak was 3.15 (1.2 to 3.9) ng/mL, which represented 78.7 times the 99th percentile. CONCLUSION: In this study, different from CK-MB findings, troponin was significantly increased in the absence of myocardial infarction on cardiac magnetic resonance. Thus, CK-MB was more accurate than troponin I for excluding procedure-related myocardial infarction. These data suggest a higher troponin cutoff for the diagnosis of coronary bypass surgery related myocardial infarction. CLINICAL TRIAL REGISTRATION: http://www.isrctn.com/ISRCTN09454308 . Registered 08 May 2012.
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Oikawa et al. (2017) conducted an observational in Coronary artery disease requiring on-pump coronary artery bypass grafting (n=54). On-pump coronary artery bypass grafting was evaluated on Occurrence of myocardial infarction based on cTnI elevation >10 times the 99th percentile in patients with no late gadolinium enhancement on CMR. After on-pump coronary artery bypass grafting without myocardial infarction on cardiac magnetic resonance, 96% of patients had troponin I elevations >10 times the 99th percentile versus 24% for CK-MB.
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