Modeling creatine-kinase MB concentrations following coronary artery bypass grafting.

Autor:	Romeo JL; Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands. Electronic address: jamieromeo@live.nl., Vriesendorp PA; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, University Medical Center, Maastricht University, Maastricht, The Netherlands., Gerritsen K; Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands., Nader M; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Mahtab E; Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Maessen JG; Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands., Van't Hof AWJ; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands., Gollmann-Tepeköylü C; Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria., van Rosmalen F; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Intensive Care Medicine, University Medical Center, Maastricht University, Maastricht, The Netherlands., van der Horst ICC; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Intensive Care Medicine, University Medical Center, Maastricht University, Maastricht, The Netherlands., Mingels AMA; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Central Diagnostic Laboratory, University Medical Center, Maastricht University, Maastricht, The Netherlands., Heuts S; Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Aug 21. Date of Electronic Publication: 2024 Aug 21.
DOI:	10.1016/j.jtcvs.2024.08.019
Abstrakt:	Background: An increase in cardiac biomarkers is a prerequisite for diagnosing periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG). Early-phase risk detection may be aided by modeling time-dependent serum creatine kinase-MB (CK-MB) concentrations. This study aimed to model the kinetics of CK-MB while identifying its influencing factors. Methods: Patients who underwent elective CABG and had CK-MB measurements within 72 hours postoperatively were included. The primary outcome was the modeled post hoc kinetics of CK-MB in patients without potential PMI. These patients were defined as having no potential PMI based on the absence of ischemic electrocardiographic abnormalities, imaging abnormalities, in-hospital cardiac arrest, mortality, or postoperative unplanned catheterization. A web-based application was created using mixed-effect modeling to provide an interactive and individualized result. Results: A total of 1589 CK-MB measurements from 635 patients who underwent elective isolated CABG were available for analysis. Of these, 609 patients (96%) had no potential PMI and 26 (4%) had potential PMI. Male sex, aortic cross-clamp time, and cardioplegia type significantly impacted CK-MB concentrations. The diagnostic accuracy of the model had an area under the receiver operating characteristic curve of 82.8% (95% confidence interval, 72.6%-90.2%). A threshold of 7 μg/L yielded a sensitivity of 94% and a specificity of 80% (positive predictive value, 17%; negative predictive value, 99%) for excluding potential PMI in our study population. Conclusions: CK-MB release after CABG depends on the timing of measurement, patient sex, aortic cross-clamp time, and cardioplegia type. The model (available at https://www.cardiomarker.com/ckmb) can be validated, reproduced, refined, and applied to other biomarkers. Competing Interests: Conflict of Interest Statement A.M.A.M. reports nonfinancial support from Abbott Diagnostics and Roche Diagnostics. A.W.J.V.H. reports unrestricted institutional grants from Abbott, Roche, Medtronic, Boehringer Ingelheim, and Astra Zeneca. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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