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

• Published in: Journal of cardiovascular surgery Vol. 44; no. 2; pp. 191 - 196
• Main Authors: Bimmel, D, Patermann, B, Schlosser, T, Winkler, K, Tiemann, K, Likungu, J A, Preusse, C J, Welz, A
• Format: Journal Article
• Language: English
• Published: Italy Edizioni Minerva Medica 01.04.2003
• Subjects: Aged; Biomarkers - blood; Coronary Artery Bypass; Creatine Kinase - blood; Creatine Kinase, MB Form; Female; Humans; Isoenzymes - blood; Male; Middle Aged; Myocardial Ischemia - diagnosis; Postoperative Period; Sensitivity and Specificity; Troponin I - blood
• ISSN: 0021-9509; 1827-191X

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. 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). 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 microg/L) had lower cTnI values compared to group B (14.8+/-5.3 microg/L) (p=0.035) and C (54+/-22.8 microg/L) (p=0.023). The cut off value was 14.8 microg/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%). 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.