Comparative Evaluation of Intra- and Postoperative Cardiac Biomarkers in On-Pump Cardiac Surgery with and Without Esmolol Infusion

Q: What are the key findings of this study?

Esmolol infusion during on-pump cardiac surgery significantly reduced first postoperative day Troponin I levels (5.32 vs 9.45 ng/ml) compared to no esmolol.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: On-pump cardiac surgery (n=40). Intervention: Esmolol infusion vs. No esmolol. Primary outcome: First postoperative day (T5) Troponin I level (ng/ml) (p=<0.001).

Q: What does this research mean for the field?

Esmolol infusion during on-pump cardiac surgery significantly reduces intra- and postoperative cardiac troponin I and CK-MB levels, providing myocardial protection against cardiopulmonary bypass-induced injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the effect of intraoperative esmolol infusion on perioperative cardiac biomarkers and myocardial stress during on-pump cardiac surgery.

doi:10.25258/ijddt.16.58s.184

October 9, 2026International Journal of Drug Delivery TechnologyOpen Access

Comparative Evaluation of Intra- and Postoperative Cardiac Biomarkers in On-Pump Cardiac Surgery with and Without Esmolol Infusion

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Key result

Esmolol infusion linked to ~44% lower postoperative troponin I in on-pump cardiac surgery.

P<0.001
n=40

Why the study?

Cardiopulmonary bypass cardiac surgery causes myocardial injury and systemic stress reflected by increased cardiac biomarkers, and the effect of esmolol on these biomarkers is unclear.

Does intravenous esmolol infusion reduce perioperative cardiac biomarker elevations in adult patients undergoing on-pump cardiac surgery?

Key Points

To evaluate the effect of intraoperative esmolol infusion on perioperative cardiac biomarkers and myocardial stress during on-pump cardiac surgery.
Comparative cross-sectional study conducted over one year in the Department of Cardiac Surgery at BSMMU.
Enrolled 40 patients via convenience sampling into Group A (n=20, received esmolol infusion) and Group B (n=20, control without esmolol).
Measured serial perioperative troponin I and CK-MB levels from baseline (T0) to the first postoperative day (T5).
Troponin I levels were significantly lower in Group A than Group B before aortic cannulation (T1: 0.11±0.19 vs 2.90±1.77 ng/ml, p<0.001) and on the first postoperative day (T5: 5.32±3.31 vs 9.45±4.56 ng/ml, p<0.001).
CK-MB levels were significantly lower in Group A compared to Group B before aortic cross-clamping (T2: 23.07±7.07 vs 27.02±7.06 IU/L, p=0.039) and on the first postoperative day (T5: 25.02±7.89 vs 41.21±29.76 IU/L, p<0.001).
Baseline age (47.9±11.18 vs 49.05±11.26 years, p=0.375) and gender (60% vs 55% male, p=0.749) were comparable between Group A and Group B.

Study Design

Type

Cross-Sectional (n=40)

Multicenter

No

Structured PICO

Does intravenous esmolol infusion reduce perioperative cardiac biomarker elevations in adult patients undergoing on-pump cardiac surgery?

P

Population

40 adult patients undergoing on-pump cardiac surgery were evaluated through the first postoperative day to assess the cardioprotective effects of esmolol infusion.

I

Intervention

Intravenous esmolol infusion administered from skin incision until initiation of cardiopulmonary bypass and continued with cardioplegia thereafter.

C

Comparator

No esmolol (both groups received standard anesthetic techniques).

O

Outcome

Intra- and postoperative cardiac biomarker levels (serum Troponin I and CK-MB) measured at predefined time points from baseline through the first postoperative day.surrogate

Main Result

Absolute Event Rate: 5.32% vs 9.45%

p-value: p=<0.001

Intraoperative esmolol infusion significantly reduces perioperative elevations of troponin I and CK-MB during on-pump cardiac surgery, suggesting a potential myocardial protective effect.

Limitations

The study did not investigate whether different doses of esmolol might have varying effects on outcomes.
The study focused on a limited set of clinical outcomes without imaging or clinical endpoints like myocardial infarction.
Relatively small number of participants.
The study is single-centered.
The study was done with different teams of surgeons.
The study needs longer follow-up periods to assess the long-term impact of esmolol on cardiac function and overall patient recovery.
Clinical outcomes such as postoperative myocardial infarction, echocardiographic ventricular assessment, or long-term outcomes were not included
Small sample size of 20 patients per group restricting generalizability
Did not investigate varying effects of different doses of esmolol
Single-centered study
Study was done with different teams of surgeons
Laboratory variability and perioperative factors could influence absolute biomarker levels

Implication

May attenuate myocardial injury markers in on-pump surgery; hypothesis-generating and should not change practice without RCTs.

Abstract

BackgroundCardiac surgery performed with cardiopulmonary bypass (CPB) is consistently associated with myocardial injury and a systemic stress response, which are manifested by perioperative increases in cardiac biomarkers such as cardiac troponins and creatine kinase-MB (CK-MB).The purpose of this study is to assess the effect of esmolol, a short-acting β-blocker, on cardiac stress during on-pump heart surgery by measuring intra-and postoperative cardiac biomarkers, to evaluate myocardial protection and enhance surgical outcomes while reducing complications.Methods This was a comparative cross-sectional study conducted in the Department of Cardiac Surgery, BSMMU, over one year.This study enrolled 40 patients (Group A: n=20, received esmolol; Group B: n=20, no esmolol) using convenience sampling.Data were collected through a questionnaire and checklist, analyzed using Chi-squared and ttests (p ≤ 0.05) in SPSS v26, with informed consent, confidentiality, and IRB approval maintained.Results Among 40 patients, age (47.9±11.18vs 49.05±11.26years, p=0.375) and gender (60% vs 55% male, p=0.749) were comparable.Troponin I (T1: 2.90±1.77vs 0.11±0.19;T5: 9.45±4.56vs 5.32±3.31ng/ml, p<0.001) and CK-MB (T2: 27.02±7.06vs 23.07±7.07;T5: 41.21±29.76vs 25.02±7.89IU/L, p<0.001) were significantly higher in Group B than Group A. Conclusion Esmolol infusion during on-pump cardiac surgery was linked to reduced intraoperative and postoperative cardiac biomarker levels compared with no esmolol use, indicating a possible protective effect on the myocardium.Thus, esmolol may serve as an effective adjunct to limit perioperative myocardial injury during cardiopulmonary bypass.

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Cite This Study

A 2026 study conducted a cross-sectional in On-pump cardiac surgery (n=40). Esmolol infusion vs. No esmolol was evaluated on First postoperative day (T5) Troponin I level (ng/ml) (p=<0.001). Esmolol infusion during on-pump cardiac surgery significantly reduced first postoperative day Troponin I levels (5.32 vs 9.45 ng/ml) compared to no esmolol.

synapsesocial.com/papers/6acf0f522fe143470d058697 https://doi.org/10.25258/ijddt.16.58s.184

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Comparative Evaluation of Intra- and Postoperative Cardiac Biomarkers in On-Pump Cardiac Surgery with and Without Esmolol Infusion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Comparative Evaluation of Intra- and Postoperative Cardiac Biomarkers in On-Pump Cardiac Surgery with and Without Esmolol Infusion

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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