de Castro Martínez Javier, Vázquez Rizaldos Sonia, Velayos Amo Carlos, Herranz Valera Jesús, Almería Varela Carlos, Iloro Mora María I
Unidad de Cuidados Intensivos y Coronarios, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Rev Esp Cardiol. 2002 Mar;55(3):245-50. doi: 10.1016/s0300-8932(02)76592-5.
Myocardial infarction after coronary artery bypass grafting is a serious complication and one of the most common causes of perioperative morbidity and mortality. The present study was designed to determine the relevance of serum cardiac troponin I as a specific diagnostic marker for perioperative myocardial infarction.
A cohort of 64 patients undergoing coronary artery bypass grafting was enrolled for prospective study. Postoperative blood samples were extracted and analyzed for total creatine kinase (CK), CKMB and cardiac troponin I activity. Perioperative infarction was defined as the development of new Q waves in the postoperative electrocardiogram together with congruent regional wall motion abnormalities in the echocardiogram and CK values greater than 400 IU/l with MB fraction greater than 40 IU/l.
Perioperative infarction occurred in 12 patients. Higher cardiac troponin I values were observed in patients experiencing perioperative myocardial infarction than in those without infarction (p < 0.001). Cardiac troponin I values higher than 12 ng/ml 10 h after release of the aortic clamp best detected the presence of perioperative myocardial infarction, with an area under the characteristic receiver operating curve of 0.91 (95% CI, 0.82-0.97), a sensitivity of 90.9%, and a specificity of 88.5%. The mean stay in the intensive care unit was significantly longer for patients who suffered perioperative myocardial infarction (6.5 8.6 days) than for patients without perioperative infarction (4.7 7.5 days) (p < 0.005).
Cardiac troponin I elevation appears to be an early, specific marker for the diagnosis of perioperative myocardial infarction after coronary artery bypass grafting.
冠状动脉搭桥术后心肌梗死是一种严重并发症，也是围手术期发病和死亡的最常见原因之一。本研究旨在确定血清心肌肌钙蛋白I作为围手术期心肌梗死特异性诊断标志物的相关性。
纳入64例接受冠状动脉搭桥术的患者进行前瞻性研究。术后采集血样，分析总肌酸激酶（CK）、CKMB和心肌肌钙蛋白I活性。围手术期梗死定义为术后心电图出现新的Q波，同时超声心动图显示相应区域室壁运动异常，且CK值大于400 IU/l，MB分数大于40 IU/l。
12例患者发生围手术期梗死。围手术期发生心肌梗死的患者心肌肌钙蛋白I值高于未发生梗死的患者（p < 0.001）。主动脉阻断钳松开10小时后，心肌肌钙蛋白I值高于12 ng/ml能最好地检测出围手术期心肌梗死的存在，特征性受试者工作曲线下面积为0.91（95%CI，0.82 - 0.97），敏感性为90.9%，特异性为88.5%。围手术期发生心肌梗死的患者在重症监护病房的平均住院时间（6.5±8.6天）显著长于未发生围手术期梗死的患者（4.7±7.5天）（p < 0.005）。
心肌肌钙蛋白I升高似乎是冠状动脉搭桥术后围手术期心肌梗死诊断的早期特异性标志物。
