Definitions of post-coronary artery bypass grafting myocardial infarction: variations in incidence and prognostic significance
| Autor: | Deborah J. Cook, Andre Lamy, Peter A. Kavsak, George Tagarakis, Kevin Kennedy, Yongning Ou, Richard P. Whitlock, Philip J. Devereaux, Emilie P. Belley-Côté, Francois Lamontagne, Jessica Vincent |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Myocardial Infarction 030204 cardiovascular system & hematology 03 medical and health sciences Coronary artery bypass surgery 0302 clinical medicine Internal medicine Myocardial Revascularization medicine Creatine Kinase MB Form Humans 030212 general & internal medicine Myocardial infarction Coronary Artery Bypass biology business.industry Incidence Hazard ratio EuroSCORE General Medicine Prognosis medicine.disease Troponin Confidence interval 3. Good health Cardiac surgery Transplantation Cardiology biology.protein Surgery Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Eur J Cardiothorac Surg |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezz161 |
| Popis: | OBJECTIVES Using data from the CORONARY trial (n = 4752), we evaluated the incidence and prognostic significance of myocardial infarction (MI) applying different definitions based on peak postoperative creatine kinase-MB isoenzyme and cardiac troponin levels. We then aimed to identify the peak cardiac troponin during the first 3 postoperative days that was independently associated with a 2-fold increase in 30-day mortality. METHODS To combine different assays, we analysed cardiac troponins in multiples of their respective upper limit of normal (ULN). We identified the lowest threshold with a hazard ratio (HR) >2 for 30-day mortality independent of EuroSCORE and on- versus off-pump surgery. RESULTS Depending on the definition used based on creatine kinase-MB, the incidence of MI after coronary artery bypass grafting (CABG) ranged from 0.6% to 19% and the associated HRs for 30-day mortality ranged from 2.7 to 6.9. Using cardiac troponin (1528 patients), the incidence of MI ranged from 1.7% to 13% depending on the definition used with HRs for 30-day mortality ranging from 5.1 to 7.2. The first cardiac troponin threshold we evaluated, 180xULN, was associated with an adjusted HR for 30-day mortality of 7.6 [95% confidence interval (CI) 3.4–17.1] when compared to CONCLUSIONS Our results illustrate that the incidence and prognosis of a post-CABG MI varies based on the definition used. Validated post-CABG MI diagnostic criteria formulated from their independent association with important clinical outcomes are needed. |
| Databáze: | OpenAIRE |
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