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Eur J Cardiothorac Surg 2005;28:114-119
© 2005 Elsevier Science NL
a Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA
b Department of Cardiovascular Surgery, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA
c Department of Medicine, Medical College of Ohio, Toledo, OH, USA
d Department of Cardiovascular Surgery, Medical College of Ohio, Toledo, OH, USA
e Department of Cardiovascular Surgery, St. Luke's Medical Center, Maumee, OH, USA
Received 21 December 2004; received in revised form 2 March 2005; accepted 4 March 2005.
* Corresponding author. Tel.: +1 419 251 4715; fax: +1 419 251 3859. (Email: engoren{at}pol.net).
Objective: The joint European Society of Cardiology and American College of Cardiology consensus statement on myocardial necrosis after revascularization stated that any amount of myocardial necrosis as detected by cardiac enzymes should be labeled a myocardial infarct. However, it also stated that more data collection is necessary to better interpret the elevation of cardiac enzymes after coronary artery bypass grafting. We sought to determine if a single postoperative value of creatine kinase-myocardial band could be used as a risk factor to help predict mortality after coronary artery bypass surgery. Methods: A retrospective analysis of prospectively collected data on 1161 patients undergoing first-time, isolated coronary artery bypass surgery utilizing normothermic cardiopulmonary bypass was conducted. Creatine kinase-myocardial band was measured the morning after surgery. Binary logistic regression, Cox proportional hazard models, and overlapping quintiles were used to illuminate the association between creatine kinase-myocardial band elevation and mortality after coronary artery bypass surgery. Results: We found a threshold value of creatine kinase-myocardial band, 40ng/mL, above which elevations were associated with increased death rates. This association held after adjustment for other factors known to contribute to postoperative mortality. However, after 1 year, there was no longer a statistically significant higher mortality associated with elevated creatinine kinase-myocardial band >40ng/mL. Conclusion: Elevation of creatine kinase-myocardial band the morning after surgery above a threshold 40ng/mL is associated with an increased risk of mortality.
Key Words: Coronary artery bypass surgery • Survival analysis • Mortality • Myocardial infarction • Myocardial injury
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