ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2003 April;44(2):191-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Do we still need CK-MB in coronary artery bypass grafting surgery?

Bimmel D., Patermann B., Schlosser T., Winkler K., Tiemann K., Likungu J. A., Preusse C. J., Welz A.

Department of Cardiac Surgery, University of Bonn, Bonn, Germany

Aim. The aim of ­this ­study was to eval­uate the ­role of car­diac Tro­ponin I (­cTnI) and CK-MB for ­early pre­dic­tion of out­come of ­patients under­going coronary artery bypass grafting (­CABG) sur­gery.
­Methods. In 134 con­sec­u­tive ­patients under­going ­CABG-sur­gery ­blood sam­ples ­were ana­lyzed for ­cTnI con­cen­tra­tion and CK-MB ­activity. ECG, hemo­dy­namic param­e­ters and the ­need for ­inotropic sup­port, ­were con­tin­u­ously reg­is­tered. ­Patients ­were ­divided ­into ­group A (uneventful ­course), ­group B (­ischemia by ECG, hemo­dy­namic ­stability) and ­group C (­ischemia by ECG and ­IABP).
­Results. ­After ­removal of X-­clamp an ­increase ­cTnI and CK-MB was ­observed in all ­patients. Five hrs ­after ­stop of CPB ­group A (8.3±4.2 µg/L) had ­lower ­cTnI ­values com­pared to ­group B (14.8±5.3 µg/L) (p=0.035) and C (54±22.8 µg/L) (p=0.023). The cut off ­value was 14.8 µg/L. Sen­si­tivity and spec­i­ficity (99%/97%) was ­higher for ­cTnI ­than for CK-MB (90%/30%). The pos­i­tive pre­dic­tive ­value of out­come was ­better for ­cTnI (86%) ­than for CK-MB (33%).
Con­clu­sion. ­CTnI is a spe­cific and sen­si­tive ­marker for eval­u­a­tion of per­i­op­er­a­tive myo­car­dial ­ischemia (PMI). Addi­tional deter­mi­na­tion of CK-MB ­activity ­does not pro­vide fur­ther clin­ical infor­ma­tion. ­CTnI ­should be the ­marker of ­first ­choice in ­CABG sur­gery.