HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Van Lente, F. Articles by Loop, F. D. Search for Related Content PubMed PubMed Citation Articles by Van Lente, F. Articles by Loop, F. D.

The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 704-710, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The predictive value of serum enzymes for perioperative myocardial infarction after cardiac operations. An autopsy study

F Van Lente, A Martin, NB Ratliff, SC Kazmierczak and FD Loop
Department of Biochemistry, Cleveland Clinic Foundation, Ohio 44195.

We evaluated the utility of serum enzyme and isoenzyme activities for detecting autopsy-proved perioperative myocardial infarction in patients who died after cardiac operations. We studied 79 patients who had autopsies performed after coronary artery bypass grafting or valve replacement, or both. Thirty-seven had histologic evidence of a perioperative myocardial infarction. We found statistically significant differences between the group of patients with infarction and the group without infarction when we compared the mean activities of creatine kinase, creatine kinase MB, aspartate aminotransferase, and the lactate dehydrogenase-1/lactate dehydrogenase-2 ratio. The postoperative changes in serum enzymes were analyzed by logistic regression for their relation to perioperative myocardial infarction. Creatine kinase MB exhibited the best diagnostic association with the presence of perioperative myocardial infarction. The lactate dehydrogenase- 1/lactate dehydrogenase-2 ratio correlated to a lesser extent with infarction. Adjustment of the diagnostic cutoff to 133 U/L for creatine kinase-MB measured 15 hours after operation yielded a sensitivity of 0.60 and a specificity of 1.0. This study demonstrates that no combination of enzyme activity changes after operation can completely discriminate all patients with perioperative myocardial infarction from those without. Nonetheless, measurement of creatine kinase MB activity provide 96% accuracy for diagnosing infarction at a prevalence of 10%.

This article has been cited by other articles:

				J. Steuer, T. Bjerner, O. Duvernoy, L. Jideus, L. Johansson, H. Ahlstrom, E. Stahle, and B. Lindahl Visualisation and quantification of peri-operative myocardial infarction after coronary artery bypass surgery with contrast-enhanced magnetic resonance imaging Eur. Heart J., August 1, 2004; 25(15): 1293 - 1299. [Abstract] [Full Text] [PDF]

				S. K. Shernan, J. C. K. Fitch, N. A. Nussmeier, J. C. Chen, S. A. Rollins, C. F. Mojcik, K. J. Malloy, T. G. Todaro, T. Filloon, S. W. Boyce, et al. Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypass Ann. Thorac. Surg., March 1, 2004; 77(3): 942 - 949. [Abstract] [Full Text] [PDF]

				T. Backstrom, M. Goiny, U. Lockowandt, J. Liska, and A. Franco-Cereceda Cardiac outflow of amino acids and purines during myocardial ischemia and reperfusion J Appl Physiol, March 1, 2003; 94(3): 1122 - 1128. [Abstract] [Full Text] [PDF]

				J. Steuer, L.-G. Horte, B. Lindahl, and E. Stahle Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting Eur. Heart J., August 1, 2002; 23(15): 1219 - 1227. [Abstract] [Full Text] [PDF]

				R. Seitelberger, T. Wild, N. Serbecic, S. Schwarzacher, M. Ploner, A. Lassnigg, and B. Podesser Significance of right bundle branch block in the diagnosis of myocardial ischemia in patients undergoing coronary artery bypass grafting Eur. J. Cardiothorac. Surg., August 1, 2000; 18(2): 187 - 193. [Abstract] [Full Text] [PDF]

				M. Carrier, M. Pellerin, L. P. Perrault, B. C. Solymoss, and L. C. Pelletier Troponin levels in patients with myocardial infarction after coronary artery bypass grafting Ann. Thorac. Surg., February 1, 2000; 69(2): 435 - 440. [Abstract] [Full Text] [PDF]

				J. C. K. Fitch, S. Rollins, L. Matis, B. Alford, S. Aranki, C. D. Collard, M. Dewar, J. Elefteriades, R. Hines, G. Kopf, et al. Pharmacology and Biological Efficacy of a Recombinant, Humanized, Single-Chain Antibody C5 Complement Inhibitor in Patients Undergoing Coronary Artery Bypass Graft Surgery With Cardiopulmonary Bypass Circulation, December 21, 1999; 100(25): 2499 - 2506. [Abstract] [Full Text] [PDF]

				R. Svedjeholm, L. G. Dahlin, C. Lundberg, Z. Szabo, B. Kagedal, E. Nylander, C. Olin, and H. Rutberg Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery? Eur. J. Cardiothorac. Surg., June 1, 1999; 13(6): 655 - 661. [Abstract] [Full Text] [PDF]

				Y. Bar-El, Z. Adler, A. Kophit, V. Kertzman, S. Sawaed, A. Ross, O. Cohen, and S. Milo Myocardial protection in operations requiring more than 2 h of aortic cross-clamping Eur. J. Cardiothorac. Surg., March 1, 1999; 15(3): 271 - 275. [Abstract] [Full Text] [PDF]

				B. K. Podesser, S. Schwarzacher, W. Zwoelfer, T. M. Binder, E. Wolner, and R. Seitelberger COMPARISON OF PERIOPERATIVE MYOCARDIAL PROTECTION WITH NIFEDIPINE VERSUS NIFEDIPINE AND METOPROLOL IN PATIENTS UNDERGOING ELECTIVE CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1461 - 1469. [Abstract] [Full Text]

				P. Menasche, W. R. E. Jamieson, W. Flameng, M. K. Davies, and on behalf of the Multinational Acadesine Study Gro ACADESINE: A NEW DRUG THAT MAY IMPROVE MYOCARDIAL PROTECTION IN CORONARY ARTERY BYPASS GRAFTINGResults of the first international multicenter study J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 1096 - 1106. [Abstract] [Full Text]