Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring high-sensitivity C-reactive protein, cardiac troponin.

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Presentation transcript:

Myocardial injury in coronary artery bypass grafting: On-pump versus off-pump comparison by measuring high-sensitivity C-reactive protein, cardiac troponin I, heart- type fatty acid–binding protein, creatine kinase-MB, and myoglobin release Ujjwal K. Chowdhury, MCh, Diplomate NB, Vishwas Malik, DM, Rakesh Yadav, DM, Sandeep Seth, DM, Lakshmy Ramakrishnan, PhD, Mani Kalaivani, MSc (Biostatistics), Srikrishna M. Reddy, MS, Ganapathy K. Subramaniam, MCh, Raghu Govindappa, MS, Madhava Kakani, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 5, Pages 1110-1119.e10 (May 2008) DOI: 10.1016/j.jtcvs.2007.12.029 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Release kinetics of high-sensitivity C-reactive protein (hs-CRP) concentrations broken down by surgical procedure (on-pump vs off-pump) at baseline (0), 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours, respectively. Dots represent the outliers that were outside the calculated range, possibly because of biologic variability. The 2 measurements differed significantly (P = .04). The hs-CRP concentration was significantly higher in the on-pump group than in the off-pump group at 4 hours (P = .04) and 8 hours (P = .009) only. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Release kinetics of cardiac troponin I (cTn-I) concentrations broken down by surgical procedure (on-pump vs off-pump) at baseline (0), 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours, respectively. Dots represent the outliers that were outside the calculated range, possibly because of biologic variability. The 2 measurements differed significantly (P = .001). The cTn-I concentration was significantly higher in the on-pump group than in the off-pump group at 1 hour (P < .0001), 2 hours (P < .0001), 4 hours (P < .0001), 8 hours (P < .0001), and 24 hours (P = .04). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Release kinetics of heart-type fatty-acid-binding-protein (h-FABP) concentrations broken down by surgical procedure (on-pump vs off-pump) at baseline (0), 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours, respectively. Dots represent the outliers that were outside the calculated range, possibly because of biologic variability. The 2 measurements differed significantly (P < .0001). The hFABP concentration was significantly higher in the on-pump group than in the off-pump group at 1 hour (P < .0001), 2 hours (P = .001), 4 hours (P = .0002), 8 hours (P = .0008), 24 hours (P = .0002), 48 hours (P = .0004), and 72 hours (P < .0001). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Release kinetics of creatine kinase-MB (CKMB) concentrations broken down by surgical procedure (on-pump vs off-pump) at baseline (0), 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours, respectively. Dots represent the outliers that were outside the calculated range, possibly because of biologic variability. The degree of CK-MB increase was significantly higher in the on-pump group at 1 hour (P = .001), 2 hours (P = .005), and 4 hours (P = .0008) only. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Release kinetics of myoglobin concentrations broken down by surgical procedure (on-pump vs off-pump) at baseline (0), 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, and 72 hours, respectively. Dots represent the outliers that were outside the calculated range, possibly because of biologic variability. The degree of myoglobin increase was significantly higher in the on-pump group at 1 hour (P = .001) and 2 hours (P = .04) only. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 The receiver operating characteristic (ROC) curve of the study group to compare the tradeoffs between the true-positive rate and the false-positive rate of increase of all cardiac biomarker levels to identify all the diagnostic discrimination limits for each markers (high-sensitivity C-reactive protein, heart-type fatty acid–binding protein, cardiac troponin I, creatine kinase-MB, and myoglobin). Cardiac troponin I and heart-type fatty acid–binding protein were superior diagnostic discriminators of myocardial injury after on-pump coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1110-1119.e10DOI: (10.1016/j.jtcvs.2007.12.029) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions