Risk factors and predictive value of the triple biomarkers for myocardial infarction in non-coronary cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHU Jiaquan , YANG Qi , ZHANG Yunjiao , ZHANG Junwen , BAO Chunrong , DING Fangbao , MEI Ju

Department of Cardiothoracic Surgery, Shanghai Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200092, P.R.China;

Corresponding?author：

ZHU Jiaquan, Email: somzjq@126.com

Keywords：

Cardiac surgery; cardiac troponin I; myoglobin; creatine kinase-MB

DOI：

10.7507/1007-4848.201701048

Video：

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Objective To investigate the perioperative change and the predictive value of myoglobin, creatine kinase-MB (CK-MB), and cardiac troponin I (cTnI) in non-coronary cardiac surgery. Methods The clinical data of 77 patients undergoing cardiac surgery for non-coronary lesions in the Shanghai Xinhua Hospital from March 2016 to November 2016 were retrospectively reviewed, including 37 males and 40 females with a median age of 2 years. There were simple congenital heart diseases in 45 patients, complicated congenital heart diseases in 10, and heart valve diseases in 22. The levels of myoglobin, CK-MB and cTnI were collected at the first postoperative day. The ventilation duration and the length of ICU stay were recorded. The recovery condition was accessed by senior surgeons. Results The myoglobin, CK-MB and cTnI concentrations increased at the first postoperative day, and cTnI increased most significantly. The multivariate linear regression analysis indicated that these changes were only related to cardiopulmonary bypass time and aortic cross-clamping time (P<0.001). The high cTnI level was associated with prolonged ventilation duration and length of ICU stay. Fourteen patients (18.2%) did not recovered well, and their cTnI level was significantly higher than that of well-recovered patients (16.8±16.7 ng/mlvs. 5.1±4.4 ng/ml,P<0.001). The cTnI cutoff value of 5.33 ng/ml could predict whether patients had good postoperative recovery (area under the receiver operating characteristic curve=0.862,P<0.001), and the predictive value of cTnI was superior to that of myoglobin and CK-MB. Conclusion The increase levels of myoglobin, CK-MB and cTnI post non-coronary cardiac surgery are associated with prolonged cardiopulmonary bypass time and aortic cross-clamping time. cTnI on postoperative 24 h may predict good recovery, and it is a useful biomarker.

Citation： ZHU Jiaquan, YANG Qi, ZHANG Yunjiao, ZHANG Junwen, BAO Chunrong, DING Fangbao, MEI Ju. Risk factors and predictive value of the triple biomarkers for myocardial infarction in non-coronary cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(11): 839-843. doi: 10.7507/1007-4848.201701048 Copy

1.	Sethi SS, Singh A, Farkouh ME. Periprocedural myocardial enzyme elevation: prognostic implications for current practice. Curr Cardiol Rep, 2012, 14(4):424-432.
2.	Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation, 2012,126(16):2020-2035.
3.	Ma QL, Wang HJ, Shi MN, et al. Serum troponin I concentrations assessed 18-24 hours after coronary artery bypass grafting are significant predictors of early patient prognosis. Eur Rev Med Pharmacol Sci, 2016,20(19):4129-4135.
4.	Croal BL, Hillis GS, Gibson PH, et al. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation, 2006,114(14):1468-1475.
5.	Saito T, Hojo Y, Hirose M, et al. High-sensitivity troponin T is a prognostic marker for patients with aortic stenosis after valve replacement surgery. J Cardiol, 2013,61(5):342-347.
6.	Momeni M, Poncelet A, Rubay J, et al. Does postoperative cardiac troponin-I vave Any Prognostic Value in Predicting Midterm Mortality After Congenital Cardiac Surgery? J Cardiothorac Vasc Anesth, 2017,31(1):122-127.
7.	李斌, 陳興澎, 王亞宏. 心肌肌鈣蛋白 I 在冠狀動脈旁路移植術后的變化規律. 中國心血管病研究, 2013, 12(11): 969-971.
8.	張海濤, 胡盛壽, 劉楠, 等. 體外循環和非體外循環搭橋過程中心肌損傷的比較. 中國體外循環雜志, 2006, 4(3): 145-147.
9.	Hashemzadeh K, Dehdilani M. Postoperative cardiac troponin I is an independent predictor of in-hospital death after coronary artery bypass grafting. J Cardiovasc Surg (Torino), 2009,50(3):403-409.
10.	Karfis EA, Kontogiorgi P, Papadopoulos G, et al. Cardiac valve surgery and myocardial damage: the role of cardiac troponin I. J Cardiovasc Surg (Torino), 2010,51(3):409-415.
11.	Belley-Cote EP, Parikh CR, Shortt CR, et al. Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study. J Thorac Cardiovasc Surg, 2016,152(1):245-251.
12.	陳林, 肖穎彬, 肖娟, 等. 不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用. 中國胸心血管外科臨床雜志, 2012, 19(4): 371-375.
13.	趙繼梅, 劉相東, 劉春, 等. 心臟體外循環手術前后血清肌鈣蛋白I的變化. 中華檢驗醫學雜志, 2001, 24(6): 357-358.
14.	呂嬌鳳, 姚全良, 王伶, 等. 體外循環心內直視手術患者血清心肌肌鈣蛋白 I 檢測的臨床意義. 實用臨床醫學, 2009, 10(7): 11-13.
15.	Adabag AS, Rector T, Mithani S, et al. Prognostic significance of elevated cardiac troponin I after heart surgery. Ann Thorac Surg, 2007,83(5):1744-1750.
16.	Lurati Buse GA, Bolliger D, Seeberger E, et al. Troponin T and B-type natriuretic peptide after on-pump cardiac surgery: prognostic impact on 12-month mortality and major cardiac events after adjustment for postoperative complications. Circulation, 2014,130(12):948-957.
17.	Linnemann B, Sutter T, Herrmann E, et al. Elevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease. J Am Coll Cardiol, 2014,63(15):1529-1538.
18.	Gober V, Hohl A, Gahl B, et al. Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery. PLoS One, 2013,8(9):e74241.
19.	Sinning JM, Hammerstingl C, Schueler R, et al. The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation. EuroIntervention, 2016,11(13):1522-1529.
20.	Paparella D, Guida P, Caparrotti S, et al. Myocardial damage influences short- and mid-term survival after valve surgery: a prospective multicenter study. J Thorac Cardiovasc Surg, 2014,148(5):2373-2379.

1. Sethi SS, Singh A, Farkouh ME. Periprocedural myocardial enzyme elevation: prognostic implications for current practice. Curr Cardiol Rep, 2012, 14(4):424-432.
2. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation, 2012,126(16):2020-2035.
3. Ma QL, Wang HJ, Shi MN, et al. Serum troponin I concentrations assessed 18-24 hours after coronary artery bypass grafting are significant predictors of early patient prognosis. Eur Rev Med Pharmacol Sci, 2016,20(19):4129-4135.
4. Croal BL, Hillis GS, Gibson PH, et al. Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation, 2006,114(14):1468-1475.
5. Saito T, Hojo Y, Hirose M, et al. High-sensitivity troponin T is a prognostic marker for patients with aortic stenosis after valve replacement surgery. J Cardiol, 2013,61(5):342-347.
6. Momeni M, Poncelet A, Rubay J, et al. Does postoperative cardiac troponin-I vave Any Prognostic Value in Predicting Midterm Mortality After Congenital Cardiac Surgery? J Cardiothorac Vasc Anesth, 2017,31(1):122-127.
7. 李斌, 陳興澎, 王亞宏. 心肌肌鈣蛋白 I 在冠狀動脈旁路移植術后的變化規律. 中國心血管病研究, 2013, 12(11): 969-971.
8. 張海濤, 胡盛壽, 劉楠, 等. 體外循環和非體外循環搭橋過程中心肌損傷的比較. 中國體外循環雜志, 2006, 4(3): 145-147.
9. Hashemzadeh K, Dehdilani M. Postoperative cardiac troponin I is an independent predictor of in-hospital death after coronary artery bypass grafting. J Cardiovasc Surg (Torino), 2009,50(3):403-409.
10. Karfis EA, Kontogiorgi P, Papadopoulos G, et al. Cardiac valve surgery and myocardial damage: the role of cardiac troponin I. J Cardiovasc Surg (Torino), 2010,51(3):409-415.
11. Belley-Cote EP, Parikh CR, Shortt CR, et al. Association of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study. J Thorac Cardiovasc Surg, 2016,152(1):245-251.
12. 陳林, 肖穎彬, 肖娟, 等. 不同心肌保護方法在雙瓣膜置換術中對心肌的保護作用. 中國胸心血管外科臨床雜志, 2012, 19(4): 371-375.
13. 趙繼梅, 劉相東, 劉春, 等. 心臟體外循環手術前后血清肌鈣蛋白I的變化. 中華檢驗醫學雜志, 2001, 24(6): 357-358.
14. 呂嬌鳳, 姚全良, 王伶, 等. 體外循環心內直視手術患者血清心肌肌鈣蛋白 I 檢測的臨床意義. 實用臨床醫學, 2009, 10(7): 11-13.
15. Adabag AS, Rector T, Mithani S, et al. Prognostic significance of elevated cardiac troponin I after heart surgery. Ann Thorac Surg, 2007,83(5):1744-1750.
16. Lurati Buse GA, Bolliger D, Seeberger E, et al. Troponin T and B-type natriuretic peptide after on-pump cardiac surgery: prognostic impact on 12-month mortality and major cardiac events after adjustment for postoperative complications. Circulation, 2014,130(12):948-957.
17. Linnemann B, Sutter T, Herrmann E, et al. Elevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease. J Am Coll Cardiol, 2014,63(15):1529-1538.
18. Gober V, Hohl A, Gahl B, et al. Early troponin T and prediction of potentially correctable in-hospital complications after coronary artery bypass grafting surgery. PLoS One, 2013,8(9):e74241.
19. Sinning JM, Hammerstingl C, Schueler R, et al. The prognostic value of acute and chronic troponin elevation after transcatheter aortic valve implantation. EuroIntervention, 2016,11(13):1522-1529.
20. Paparella D, Guida P, Caparrotti S, et al. Myocardial damage influences short- and mid-term survival after valve surgery: a prospective multicenter study. J Thorac Cardiovasc Surg, 2014,148(5):2373-2379.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors and predictive value of the triple biomarkers for myocardial infarction in non-coronary cardiac surgery

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