The last (third) universal definition of perioperative MI after CABG is "Myocardial infarction associated with CABG is arbitrarily defined by elevation of cardiac biomarker values >10 x 99th percentile URL in patients with normal baseline cTn values (£99th percentile URL). In addition, either (i) new pathological Q waves or new LBBB, or (ii) angiographic documented new graft or new native coronary artery occlusion, or (iii) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality."
Moreover, the full text explains that as for PCI, the existing principles from the universal definition of MI should be applied for the definition of MI 48 h after surgery.
In your clinical practice, which cardiac biomarker do you use for the diagnosis of postoperative MI?
Moreover, up to how long after operation you consider valid the dosage of cardiac biomarker for the diagnosis of MI after CABG (more or less 12, 24 or 48 hours) ?
Which is the treshold of the cardiac biomarker you use for the diagnosis of MI?
Do you associate ECO- or EKG-signs with the elevation of biomarker?
Thank you.
My own personal opinion about Peri and post-operative MIs is that a significant MI with concomitant graft closure or anatomically correctable issues is always associated with hemodynamic instability often unexplained by other reasoning. Just the simple rise in biomarkers is not necessarily a cause for alarm as that often depends on the amount of myocardium dissected for the exposure. Often times a deeply myocardial vessel may involve significant myocardial dissection. Also renal insufficiency will contribute to some extent to the clearance of these markers. EKG changes unless striking and consistently present are often related to axis changes secondary to pericardiotomy and pericardial injury and are not always reliable. This is my personal opinion and my practice. When strongly suspected, a good echo with changes in regional wall motion may be another instrument to document.
Beek-8, E.C. van [[email protected]]
This guy from the Utrecht university performed a study in 2014 on this topic
I would suggest you to contact him to receive the results
Please find the link to the article
http://jaha.ahajournals.org/content/4/1/e001401.full.pdf+html
Thanks John for your kind interest
I am particularly interested in this topic. Indeed, in our center we are conducting a study on the incidence of postoperative MI after extented coronary endarterectomy and reconstruction with mammary artery patch, technique which at our center has been developed since several years with excellent results by Dr. Georges Popoff.
You can see our preliminary results on my most recently uploaded conference papers.
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