Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: A study using biomarkers and cardiac magnetic resonance imaging

Chris C S Lim, Florim Cuculi, William J. Van Gaal, Luca Testa, Jayanth R. Arnold, Theodoros Karamitsos, Jane M. Francis, Janet E. Digby, Charalambos Antoniades, Rajesh K. Kharbanda, Stefan Neubauer, Stephen Westaby, Adrian P. Banning

Research output: Contribution to journalArticle

Abstract

Background: Myocardial injury related to coronary artery bypass grafting (CABG) is poorly characterized, and understanding the characteristic release of biomarkers associated with revascularization injury might provide novel therapeutic opportunities. This study characterized early changes in biomarkers after revascularization injury during on-pump CABG. Methods: This prospective study comprised 28 patients undergoing on-pump CABG and late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) who underwent measurements of cardiac troponin I (cTnI), creatine kinase-MB, and inflammatory markers (C-reactive protein, serum amyloid A, myeloperoxidase, interleukin 6, tumor necrosis factor-α, matrix metalloproteinase 9a, monocyte chemotactic protein-1, plasminogen activator inhibitor-1a) at baseline, at 1, 6, 12, and 24 hours, and at 1 week (inflammatory markers only) post-CABG. Biomarker results at 1 hour were studied for a relationship to new myocardial infarction as defined by CMRI-LGE, and the diagnostic utility of combining positive biomarkers was assessed. Results: All patients had an uneventful recovery, but 9 showed a new myocardial infarction demonstrated by new areas of hyperenhancement on CMR. Peak cTnI at 24 hours (ρ = 0.66, p <0.001) and CK-MB (ρ = 0.66, p <0.001) correlated with the amount of new LGE. At 1 hour, 3 biomarkerscTnI, interleukin 6, and tumor necrosis factor-αwere significantly elevated in patients with vs those without new LGE. Receiver operating curve analysis showed cTnI was the most accurate at detecting new LGE at 1 hour: a cutoff of cTnI exceeding 5 μg/L at 1 hour had 67% sensitivity and 79% specificity for detecting new LGE. Conclusions: Unexpected CABG-related myocardial injury occurs in a significant proportion of patients. A cTnI test at 1 hour after CABG could potentially differentiate patients with significant revascularization injury.

Original languageEnglish
Pages (from-to)2046-2053
Number of pages8
JournalAnnals of Thoracic Surgery
Volume92
Issue number6
DOIs
Publication statusPublished - Dec 2011

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Gadolinium
Troponin I
Coronary Artery Bypass
Early Diagnosis
Biomarkers
Myocardial Infarction
Magnetic Resonance Imaging
Wounds and Injuries
Interleukin-6
Tumor Necrosis Factor-alpha
Serum Amyloid A Protein
Plasminogen Inactivators
MB Form Creatine Kinase
Chemokine CCL2
Matrix Metalloproteinases
C-Reactive Protein
Peroxidase
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Early diagnosis of perioperative myocardial infarction after coronary bypass grafting : A study using biomarkers and cardiac magnetic resonance imaging. / Lim, Chris C S; Cuculi, Florim; Van Gaal, William J.; Testa, Luca; Arnold, Jayanth R.; Karamitsos, Theodoros; Francis, Jane M.; Digby, Janet E.; Antoniades, Charalambos; Kharbanda, Rajesh K.; Neubauer, Stefan; Westaby, Stephen; Banning, Adrian P.

In: Annals of Thoracic Surgery, Vol. 92, No. 6, 12.2011, p. 2046-2053.

Research output: Contribution to journalArticle

Lim, CCS, Cuculi, F, Van Gaal, WJ, Testa, L, Arnold, JR, Karamitsos, T, Francis, JM, Digby, JE, Antoniades, C, Kharbanda, RK, Neubauer, S, Westaby, S & Banning, AP 2011, 'Early diagnosis of perioperative myocardial infarction after coronary bypass grafting: A study using biomarkers and cardiac magnetic resonance imaging', Annals of Thoracic Surgery, vol. 92, no. 6, pp. 2046-2053. https://doi.org/10.1016/j.athoracsur.2011.05.019
Lim, Chris C S ; Cuculi, Florim ; Van Gaal, William J. ; Testa, Luca ; Arnold, Jayanth R. ; Karamitsos, Theodoros ; Francis, Jane M. ; Digby, Janet E. ; Antoniades, Charalambos ; Kharbanda, Rajesh K. ; Neubauer, Stefan ; Westaby, Stephen ; Banning, Adrian P. / Early diagnosis of perioperative myocardial infarction after coronary bypass grafting : A study using biomarkers and cardiac magnetic resonance imaging. In: Annals of Thoracic Surgery. 2011 ; Vol. 92, No. 6. pp. 2046-2053.
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AU - Lim, Chris C S

AU - Cuculi, Florim

AU - Van Gaal, William J.

AU - Testa, Luca

AU - Arnold, Jayanth R.

AU - Karamitsos, Theodoros

AU - Francis, Jane M.

AU - Digby, Janet E.

AU - Antoniades, Charalambos

AU - Kharbanda, Rajesh K.

AU - Neubauer, Stefan

AU - Westaby, Stephen

AU - Banning, Adrian P.

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