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Eur J Cardiothorac Surg 2007;32:481-487. doi:10.1016/j.ejcts.2007.06.015
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Myocardial injury after off-pump coronary artery bypass grafting operation

Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Italy

Received 19 March 2007; received in revised form 29 May 2007; accepted 14 June 2007.

^_* Corresponding author. Address: Division of Cardiac Surgery, Dipartimento d’Emergenza e Trapianti d’Organo (D.E.T.O.), University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy. Tel.: +39 0805595075. (Email: dpaparella{at}cardiochir.uniba.it).

Objective: Perioperative myocardial ischemia is less pronounced in off-pump coronary artery bypass (OPCAB) compared to on-pump coronary artery bypass; however, the threshold over which the postoperative release of cardiac troponin I (cTnI) release and creatine kinase-MB (CK-MB) after OPCAB should be considered clinically relevant is unknown. The study was designated to evaluate if perioperative myocardial damage, measured by means of postoperative release of cTnI and CK-MB, has an influence on short- and mid-term outcome after OPCAB operations. Methods: Two hundred and sixty-one unselected patients undergoing OPCAB had cTnI and CK-MB measured preoperatively and nine times postoperatively. Postoperative peak values were evaluated and the 80th percentiles were used to segregate the population into two groups for each marker. The following cut-offs were used: 7.1 ng/dl for cTnI peak and 36.3 ng/dl for CK-MB peak. Results: Patients with cTnI >7.1 ng/ml (n = 51) and CK-MB >36.3 ng/ml (n = 48) had a longer mechanical ventilation and ICU length of stay. Nevertheless, hospital mortality did not differ between groups. Survival after 3 years was 92.8 ± 2.3% and 81.8 ± 6.2 for patients with postoperative cTnI peak 7.1 ng/ml and >7.1 ng/ml, respectively (p = 0.003). It was 93 ± 2.2% and 80 ± 6.8% for patients with CK-MB 36.3 ng/ml and >36.3 ng/ml, respectively (p = 0.005). Adjusted hazard ratios for mid-term mortality were HR 2.7 (CI 1–7.6), p = 0.05 for cTnI >7.1 ng/dl and HR 3.1 (CI 1–9.1), p = 0.04 for CK-MB >36.3 ng/ml. Conclusion: Perioperative myocardial damage should not be considered an innocuous event following OPCAB operations since the survival rate over 3 years is significantly worse in patients with the highest postoperative peak release of cTnI and CK-MB.

Key Words: Coronary artery bypass grafting • CABG • Myocardial injury • Survival analysis • Off-pump