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Thorac Cardiovasc Surg 2001; 49(3): 137-143
DOI: 10.1055/s-2001-14289
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Patterns and Diagnostic Value of Cardiac Troponin I vs. Troponin T and CKMB after OPCAB Surgery[*]

A. A. Peivandi1 , M. Dahm1 , U. Hake1 , G. Hafner2 , U. T. Opfermann1 , A. H. Loos3 , I. Tzanova4 , H. Oelert1
  • 1Departments for Cardiothoracic- and Vascular Surgery
  • 2Institute of Clinical Chemistry
  • 3Institute of Medical Statistics and
  • 4Department of Anesthesiology, Johannes Gutenberg- University Hospital, Mainz, Germany
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Publication History

Publication Date:
31 December 2001 (online)

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Background: Cardiac troponin I (cTnI) has been shown to be a specific marker for myocardial injury in cardiac surgery. The object of this prospective study was to determine the patterns and kinetic and diagnostic value of cTnI, cardiac troponin T (cTnT), and creatine kinase MB (CKMB) activity after minimally invasive coronary revascularization using an octopus device on the beating heart (OPCAB). Methods: 48 patients (33 male/15 female, mean age 68.3 ± 8.7 years) underwent their first elective OPCAB surgery with median sternotomy without mortality. The mean number of grafts was 2.0 ± 0.8 per patient. Preoperative mean ejection fraction was 56.6 % ± 14.9 %. CTnI and T levels, total creatine kinase (CK) and CK-MB activity in the serum were measured before operation, at arrival at the ICU, and 6, 12, 24, 48 and 120 hours afterward. Serial 12-lead ECGs were recorded preoperatively and at days 1, 2 and 5. The relationship between perioperative data and postoperative cTnI and cTnT levels and CKMB were statistically identified for all variables. Results: The best cutoff value for cTnI was 8.35 µg/l. The patients were grouped by the ECG findings and maximal slopes of cTnI postoperatively (group I: unchanged ECG and cTnI < 8.35 µg/l, n = 38; group II: unchanged ECG and cTnI > 8.35 µg/l n = 6; group III: Q-wave in ECG and cTnI > 8.35 µg/l, n = 4). Baseline serum concentrations of cTnI were in the normal range, and significantly increased after surgery with a peak 24 h after the operation. Maximal slopes of cTnI ranged in group II between 9.1 and 18.0 µg/l, and in group III between 35.9 and 88.8 µg/l. There was a strong concordance between maximum cTnI, cTnT (p < 0.0001) and CK-MB levels (p = 0.003). First cTnI levels immediately post-op correlated with the maximum cTnI levels during the postoperative course (p = 0.009). Conclusions: CTnI after minimal invasive surgery shows a characteristic pattern with a maximum at 24 h after the operation. The measurement of postoperative biochemical marker concentrations, specially cTnI, reflects myocardial injury incurred during the procedure. It is an accurate method for confirming or excluding a perioperative myocardial injury diagnosis after OPCAB surgery.

Key words:

Troponin I - Troponin T - Coronary surgery - Off-pump - Beating heart

1 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Lucerne, Switzerland, February 9 to 12, 2000

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1 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Lucerne, Switzerland, February 9 to 12, 2000

MD Ali Asghar Peivandi

Deptartment of Cardiothoracic and Vascular Surgery
Johannes Gutenberg-University Hospital

Langenbeckstraße 1

55131 Mainz

Germany

Phone: +49 6131 172911

Fax: +496131 176626

Email: peivandi@mail.uni-mainz.de