Gensini G F, Fusi C, Conti A A, Calamai G C, Montesi G F, Galanti G, Noferi D, Carbonetto F, Palmarini M F, Abbate R, Vaccari M
Department of Internal Medicine and Cardiology, University of Florence, Italy.
Crit Care Med. 1998 Dec;26(12):1986-90. doi: 10.1097/00003246-199812000-00025.
To monitor cardiac troponin I (cTnI), a newly developed biochemical index for cardiac damage, in patients during and after coronary artery bypass surgery (CABS) to determine whether the measurement of the serum levels of this marker could be of value in formulating an early diagnosis of Q-wave perioperative myocardial infarction (PMI).
Prospective study with sequential measurements of biological markers in a selected surgical patient group.
University research laboratory and general university hospital (Cardiac Surgery Unit and Anesthesiology and Reanimation Unit).
Forty-two patients undergoing elective CABS without concomitant valvular replacement.
There were no interventions required for this study. However, patients entered into the study had CABS, sequential arterial blood samples, ECG recordings, and echocardiograms performed.
Pre-, intra-, and postoperative (up to 48 hrs) measurements of cardiac troponin I, MB-CK, and total creatine kinase, as well as serial electrocardiograms and echocardiograms. Perioperative infarction was assessed as the development of new persistent regional wall motion abnormalities in echocardiography together with electrocardiographic alterations and MB-CK increases. Eight patients had Q-wave PMI. All PMI patients had elevated peak cTnI values (all >9.2 ng/mL), whereas the 34 nonPMI patients had peak values <9.0 ng/mL; therefore, sensitivity and specificity (with a 9.0 ng/mL cut-off value) are 100%. MB-CK measurement peak values did not demonstrate such a high specificity and sensitivity.
Because of its high specificity and sensitivity, serial measurements of cTnI provide a rapid and accurate method for confirming or excluding the diagnosis of perioperative myocardial injury. cTnI evaluation can therefore be used both as an independent prognostic marker for patients undergoing cardiac surgery and as a powerful tool for detecting smaller PMIs often missed with standard PMI diagnostic criteria.
监测冠状动脉搭桥手术（CABS）期间及术后患者的心肌肌钙蛋白I（cTnI），这是一种新开发的心脏损伤生化指标，以确定检测该标志物的血清水平对围手术期Q波心肌梗死（PMI）的早期诊断是否有价值。
对选定手术患者组进行生物标志物连续测量的前瞻性研究。
大学研究实验室和综合大学医院（心脏外科、麻醉与复苏科）。
42例行择期CABS且未同时行瓣膜置换术的患者。
本研究无需干预措施。然而，纳入研究的患者接受了CABS、连续动脉血样采集、心电图记录和超声心动图检查。
术前、术中及术后（至48小时）测量心肌肌钙蛋白I、肌酸激酶同工酶MB（MB-CK）和总肌酸激酶，以及系列心电图和超声心动图。围手术期梗死通过超声心动图上新出现的持续性局部室壁运动异常、心电图改变及MB-CK升高来评估。8例患者发生Q波PMI。所有PMI患者的cTnI峰值均升高（均>9.2 ng/mL），而34例非PMI患者的峰值<9.0 ng/mL；因此，以9.0 ng/mL为临界值时，其敏感性和特异性均为100%。MB-CK测量的峰值未显示出如此高的特异性和敏感性。
由于其高特异性和敏感性，连续测量cTnI为确认或排除围手术期心肌损伤的诊断提供了一种快速准确的方法。因此，cTnI评估既可以作为心脏手术患者的独立预后标志物，也可以作为检测标准PMI诊断标准常常漏诊的较小PMI的有力工具。
