Lehot J J, Durand P G, Bastien O, Bompard D, George M, Boch C, Guidollet J, Louisot P, Boissel J P, Estanove S
Département d'Anesthésie et de Réanimation Chirurgicale, Hôpital Cardiovasculaire et Pneumologique Louis-Pradel, Lyon.
Ann Fr Anesth Reanim. 1988;7(5):370-6. doi: 10.1016/s0750-7658(88)80052-2.
The usefulness of measuring serum MB creatine kinase activity (CK-MB) for the diagnosis of per- and postoperative myocardial infarction (MI) was assessed in 104 patients undergoing coronary artery bypass grafts. In each patient, 15 samples were taken during the week which followed the surgical procedure. New Q waves were considered to be a criteria of MI. 19 patients developed new Q waves (MI group), whereas 57 had no significant ECG changes (control group); 13 showed only ST changes, whilst 15 had unassessable recordings. In the MI group, CK-MB was greater than in the control group, both at the first peak (8 to 10 h after induction of anaesthesia) and at the greater peak (13 to 21 h after induction) (p less than 0.05). Significant differences were also seen between both groups between 8 and 32 h after induction, but there was also a large overlap. An area under the curve (AUC) greater than 50,000 IU.l-1.min-1 had a positive predictive value of 0.64, and an AUC less than 50,000 IU.l-1.min-1 a negative predictive value of 0.89 if all the groups of patients were taken into account. An AUC greater than 65,000 IU.l-1.min-1 was always seen in MI patients, but only 25% of MI patients had a value greater than this threshold. There were no significant differences between the patient groups in the first peak time, nor in the CK-MB/total CK ratio. CK-MB appeared therefore as a less reliable criterium of per- and postoperative MI during coronary artery bypass operations than previously reported, especially when intermediate values are found.
在104例行冠状动脉搭桥术的患者中，评估了测量血清肌酸激酶MB活性（CK-MB）对围手术期和术后心肌梗死（MI）诊断的有用性。在每位患者术后一周内采集15份样本。新出现的Q波被视为心肌梗死的一项标准。19例患者出现了新的Q波（心肌梗死组），而57例患者心电图无明显变化（对照组）；13例仅表现为ST段改变，15例记录无法评估。在心肌梗死组中，无论是在第一个峰值（麻醉诱导后8至10小时）还是在更大的峰值（麻醉诱导后13至21小时），CK-MB均高于对照组（p<0.05）。在诱导后8至32小时，两组之间也存在显著差异，但也有很大的重叠。如果将所有患者组考虑在内，曲线下面积（AUC）大于50,000 IU·l⁻¹·min⁻¹时阳性预测值为0.64，AUC小于50,000 IU·l⁻¹·min⁻¹时阴性预测值为0.89。心肌梗死患者总是出现AUC大于65,000 IU·l⁻¹·min⁻¹的情况，但只有25%的心肌梗死患者的值高于此阈值。患者组之间在第一个峰值时间以及CK-MB/总CK比值方面没有显著差异。因此，在冠状动脉搭桥手术期间，CK-MB作为围手术期和术后心肌梗死的标准不如先前报道的可靠，尤其是当出现中间值时。
