Objective To identify clinical significance of high level cardiac troponin I （cTnI） in the early postoperative period of off-pump coronary artery bypass grafting （OPCAB） and its predictive value for early clinical outcomes. Methods A total of 240 patients undergoing isolated OPCAB in the Department of Cardiac Surgery of People’s Hospitalof Peking University during 2011 were recruited in the study. There were 164 males and 76 females with their age of 36-83（62.07±8.24） years. Serum cTnI levels in 4-6 hours and 12-18 hours after OPCAB were monitored. Influential factors and its predictive value for early clinical outcomes of OPCAB were analyzed. Binary logistic regression analysis，correlation analysis and receiver operating characteristic （ROC） curve were performed for statistic analysis. Results Serum cTnI level in 4-6 hours after OPCAB （TNI0） was 1.28±0.40 ng/ml，and serum cTnI level in 12-18 hours after OPCAB （TNI1） was 3.60±0.74 ng/ml. Binary logistic regression analysis revealed that graft number was significant influential factors of TNI0 （P=0.000） and TNI1 （P=0.010）. Serum cTnI level in 12-18 hours after OPCAB was significantly correlated with early clinicaloutcomes of OPCAB （P＜0.05），but the correlational relationship was not b （correlation coefficient＜0.5）. ROC curveanalysis showed that serum cTnI level in 12-18 h after OPCAB had higher predictive value for patient prognosis （P＜0.05）. Serum cTnI level higher than 1.49 ng/ml in 12-18 h after OPCAB had good predictive value for postoperative ECG changes，use of intra-aortic balloon pump （IABP） and in-hospital mortality. Conclusions Serum cTnI level increases in varying degrees in the early postoperative period of OPCAB. Together with ECG changes，serum cTnI level can be used for early diagnosis of perioperative myocardial infarction with significant predictive value for early clinical outcomes of OPCAB.
Citation：
YANG Wei,CHEN Yu,LING Yunpeng,CHEN Shenglong,LIU Gang,DONG Suixin,LI Hui,BAO Liming.. Clinical Value of Cardiac Troponin I in the Early Postoperative Period of Off-pump Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 658-663. doi: 10.7507/1007-4848.20130206
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Etievent JP， Chocron S， Toubin G， et al. Use of cardiac troponin I as a marker of perioperative myocardial ischemia. Ann Thorac Surg， 1995， 59 （5）：1192-1194.
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Vermes E， Mesguich M， Houel R， et al. Cardiac troponin I release after open heart surgery： a marker of myocardial protection. Ann Thorac Surg， 2000， 70 （6）：2087-2090.
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周峰， 高长青， 李伯君. 非体外循环与常规冠状动脉旁路移植术后心肌酶的动态变化. 中国胸心血管外科临床杂志， 2004， 11 （4）：256-258.
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Fellahi JL， Léger P， Philippe E， et al. Pericardial cardiac troponin I release after coronary artery bypass grafting. Anesth Analg， 1999， 89 （4）：829-834.
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De Paulis R， Colagrande L， Seddio F， et al. Levels of troponin I and cardiac enzymes after reinfusion of shed blood in coronary operations. Ann Thorac Surg， 1998， 65 （6）：1617-1620.
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Hillis LD， Smith PK， Anderson JL， et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery： executive summary： a report of the American College of Cardiology Foundation/AmericanHeart Association Task Force on Practice Guidelines. J ThoracCardiovasc Surg， 2012， 143 （1）：4-34.
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Eigel P， van Ingen G， Wagenpfeil S. Predictive value of perioperativecardiac troponin I for adverse outcome in coronary artery bypasssurgery. Eur J Cardiothorac Surg， 2001， 20 （3）：544-549.
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Alexander JH， Hafley G， Harrington RA， et al. Efficacy and safety of edifoligide， an E2F transcription factor decoy， for prevention of vein graft failure following coronary artery bypass graft surgery： PREVENT IV： a randomized controlled trial. JAMA， 2005， 294 （19）：2446-2454.
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- 1. Horvath KA， Parker MA， Frederiksen JW， et al. Postoperativetroponin I values： insult or injury ? Clin Cardiol， 2000， 23 （10）：731-733.
- 2. Mair J， Larue C， Mair P， et al. Use of cardiac troponin I to diagnoseperioperative myocardial infarction in coronary artery bypass grafting.Clin Chem， 1994， 40 （11 Pt 1）：2066-2070.
- 3. Etievent JP， Chocron S， Toubin G， et al. Use of cardiac troponin I as a marker of perioperative myocardial ischemia. Ann Thorac Surg， 1995， 59 （5）：1192-1194.
- 4. Vermes E， Mesguich M， Houel R， et al. Cardiac troponin I release after open heart surgery： a marker of myocardial protection. Ann Thorac Surg， 2000， 70 （6）：2087-2090.
- 5. 肖苍松， 高长青， 朱朗标， 等. 冠状动脉旁路移植术围术期心肌肌钙蛋白I动态变化. 中华胸心血管外科杂志， 2000， 16 （4）：32-34.
- 6. Noora J， Ricci C， Hastings D， et al. Determination of troponin I release after CABG surgery. J Card Surg， 2005， 20 （2）：129-135.
- 7. Kilger E， Pichler B， Weis F， et al. Markers of myocardial ischemia after minimally invasive and conventional coronary operation. Ann Thorac Sury， 2000， 70 （6）：2023-2028.
- 8. Birdi I， Caputo M， Hutter JA， et al. Troponin I release during minimally invasive coronary artery surgery. J Thorac Cardiovasc Surg， 1997， 114 （3）：509-510.
- 9. 周峰， 高长青， 李伯君. 非体外循环与常规冠状动脉旁路移植术后心肌酶的动态变化. 中国胸心血管外科临床杂志， 2004， 11 （4）：256-258.
- 10. Fellahi JL， Léger P， Philippe E， et al. Pericardial cardiac troponin I release after coronary artery bypass grafting. Anesth Analg， 1999， 89 （4）：829-834.
- 11. De Paulis R， Colagrande L， Seddio F， et al. Levels of troponin I and cardiac enzymes after reinfusion of shed blood in coronary operations. Ann Thorac Surg， 1998， 65 （6）：1617-1620.
- 12. Hillis LD， Smith PK， Anderson JL， et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery： executive summary： a report of the American College of Cardiology Foundation/AmericanHeart Association Task Force on Practice Guidelines. J ThoracCardiovasc Surg， 2012， 143 （1）：4-34.
- 13. Eigel P， van Ingen G， Wagenpfeil S. Predictive value of perioperativecardiac troponin I for adverse outcome in coronary artery bypasssurgery. Eur J Cardiothorac Surg， 2001， 20 （3）：544-549.
- 14. Alexander JH， Hafley G， Harrington RA， et al. Efficacy and safety of edifoligide， an E2F transcription factor decoy， for prevention of vein graft failure following coronary artery bypass graft surgery： PREVENT IV： a randomized controlled trial. JAMA， 2005， 294 （19）：2446-2454.
