Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study
Objective The definition of coronary artery bypass graft (CABG)-associated myocardial infarction (MI) is controversial because the postoperative increases in cardiac enzyme activities are multifactorial in origin. Methods We performed a retrospective case–control study of patients who experienced pe...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2025-01-01
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| Series: | Journal of International Medical Research |
| Online Access: | https://doi.org/10.1177/03000605241306866 |
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| author | Lars Niclauss Liam-Kani Roulet Piergiorgio Tozzi Filip Dulguerov Ziyad Gunga Anna Nowacka Matthias Kirsch |
| author_facet | Lars Niclauss Liam-Kani Roulet Piergiorgio Tozzi Filip Dulguerov Ziyad Gunga Anna Nowacka Matthias Kirsch |
| author_sort | Lars Niclauss |
| collection | DOAJ |
| description | Objective The definition of coronary artery bypass graft (CABG)-associated myocardial infarction (MI) is controversial because the postoperative increases in cardiac enzyme activities are multifactorial in origin. Methods We performed a retrospective case–control study of patients who experienced perioperative MI (cardiac enzyme release, electrocardiographic changes, dysfunction on echocardiography) and those without ischemia to identify risk factors and enzyme activity thresholds. Results The estimated incidence of CABG-associated MI was 2.8%. The risk factors were a family history of cardiovascular disease (odds ratio (OR) 2.8), tobacco abuse (OR 3.8), recent MI (OR 3.6), and triple-vessel disease (OR 2.8). The MI group showed higher mortality (OR 2.3), prolonged intubation (OR 3.1), and a prolonged stay in intensive care (OR 4.3). The type 5 MI threshold (10 times the upper limit of the reference range (URL)) was exceeded in 88.4% (troponin I) and 96% (high-sensitivity troponin T; hs-cTnT) of patients without ischemia. Conclusions The frequent exceeding of conventional MI-indicating thresholds in patients without ischemia indicates their low specificity. An enzyme activity increase alone is of limited diagnostic value for perioperative MI, which is associated with greater mortality. Finally, the use of a higher threshold for hs-cTnT (>45 × URL) may increase its specificity for graft failure. |
| format | Article |
| id | doaj-art-a8b222f48fc540bea8806c9208fab4dc |
| institution | Kabale University |
| issn | 1473-2300 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of International Medical Research |
| spelling | doaj-art-a8b222f48fc540bea8806c9208fab4dc2025-01-27T13:03:51ZengSAGE PublishingJournal of International Medical Research1473-23002025-01-015310.1177/03000605241306866Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control studyLars NiclaussLiam-Kani RouletPiergiorgio TozziFilip DulguerovZiyad GungaAnna NowackaMatthias KirschObjective The definition of coronary artery bypass graft (CABG)-associated myocardial infarction (MI) is controversial because the postoperative increases in cardiac enzyme activities are multifactorial in origin. Methods We performed a retrospective case–control study of patients who experienced perioperative MI (cardiac enzyme release, electrocardiographic changes, dysfunction on echocardiography) and those without ischemia to identify risk factors and enzyme activity thresholds. Results The estimated incidence of CABG-associated MI was 2.8%. The risk factors were a family history of cardiovascular disease (odds ratio (OR) 2.8), tobacco abuse (OR 3.8), recent MI (OR 3.6), and triple-vessel disease (OR 2.8). The MI group showed higher mortality (OR 2.3), prolonged intubation (OR 3.1), and a prolonged stay in intensive care (OR 4.3). The type 5 MI threshold (10 times the upper limit of the reference range (URL)) was exceeded in 88.4% (troponin I) and 96% (high-sensitivity troponin T; hs-cTnT) of patients without ischemia. Conclusions The frequent exceeding of conventional MI-indicating thresholds in patients without ischemia indicates their low specificity. An enzyme activity increase alone is of limited diagnostic value for perioperative MI, which is associated with greater mortality. Finally, the use of a higher threshold for hs-cTnT (>45 × URL) may increase its specificity for graft failure.https://doi.org/10.1177/03000605241306866 |
| spellingShingle | Lars Niclauss Liam-Kani Roulet Piergiorgio Tozzi Filip Dulguerov Ziyad Gunga Anna Nowacka Matthias Kirsch Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study Journal of International Medical Research |
| title | Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study |
| title_full | Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study |
| title_fullStr | Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study |
| title_full_unstemmed | Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study |
| title_short | Perioperative infarction during coronary bypass surgery: an attempt to refine the diagnostic criteria using data from a retrospective case–control study |
| title_sort | perioperative infarction during coronary bypass surgery an attempt to refine the diagnostic criteria using data from a retrospective case control study |
| url | https://doi.org/10.1177/03000605241306866 |
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