Mangano D T
Anesthesiology. 1994 Dec;81(6):1317-20.
Diagnosis of perioperative myocardial infarction remains an important but challenging task. Both clinical symptoms and electrocardiographic changes have inherent limitations. Therefore, biochemical markers for myocardial injury are critical diagnostic tools. The use of creatine kinase isoenzymes (CK-MB) has enhanced detection of perioperative myocardial infarction; however, skeletal muscle damage during surgery limits CK-MB specificity. In this regard, the cardiac troponins appear to offer increased sensitivity, primarily because of their prolonged diagnostic window and even may offer enhanced specificity (especially troponin-I) in patients with surgical skeletal muscle damage. In addition, the convenience of relatively infrequent sampling (because of the prolonged diagnostic window), as well as potential cost savings, make use of the troponin markers attractive. However, definitive data in high-risk patients undergoing either cardiac or noncardiac surgery are still lacking, and significant questions remain regarding appropriate thresholds, specificity of troponin-T, and comparative accuracy of troponin-T, troponin-I, and CK-MB for diagnosis (and prognosis) of perioperative myocardial infarction.
围手术期心肌梗死的诊断仍然是一项重要但具有挑战性的任务。临床症状和心电图变化都有其固有的局限性。因此，心肌损伤的生化标志物是关键的诊断工具。肌酸激酶同工酶（CK-MB）的应用提高了围手术期心肌梗死的检测率；然而，手术期间的骨骼肌损伤限制了CK-MB的特异性。在这方面，心肌肌钙蛋白似乎具有更高的敏感性，主要是因为其诊断窗口期延长，并且在手术引起骨骼肌损伤的患者中甚至可能具有更高的特异性（尤其是肌钙蛋白I）。此外，由于诊断窗口期延长，采样相对不频繁带来的便利性以及潜在的成本节约，使得肌钙蛋白标志物的应用颇具吸引力。然而，对于接受心脏手术或非心脏手术的高危患者，仍缺乏确凿的数据，并且在围手术期心肌梗死的诊断（和预后）方面，关于合适的阈值、肌钙蛋白T的特异性以及肌钙蛋白T、肌钙蛋白I和CK-MB的比较准确性等重大问题仍然存在。
