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Eur J Cardiothorac Surg 1998;13:655-661
© 1998 Elsevier Science NL
a Departments of Cardiothoracic Surgery, Linköping Heart Center, University Hospital, S-581 85 Linköping, Sweden
b Cardiothoracic Anesthesia, Linköping Heart Center, University Hospital, S-581 85 Linköping, Sweden
c Clinical Physiology, Linköping Heart Center, University Hospital, S-581 85 Linköping, Sweden
d Department of Cardiothoracic Surgery, Debrecen, Hungary
e Department of Clinical Chemistry, University Hospital, S-581 85 Linköping, Sweden
Received 16 December 1997; received in revised form 23 March 1998; accepted 31 March 1998.
Corresponding author. Tel.: +46 1322 2000; fax: +46 1310 0246; e-mail: rolf.svedjeholm@thx.us.lio.se
Objective: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI. Methods: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course. Results: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB
70 µg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (<0.2 µg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome. Conclusions: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.
Key Words: Cardiac surgery • Myocardial infarction • Diagnosis • Electrocardiography • Troponin-T • Creatine phospokinase isoenzyme MB
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