Featured Research

from universities, journals, and other organizations

Elevated levels of cardiac biomarkers following CABG surgery associated with increased risk of death

Date:
February 9, 2011
Source:
JAMA and Archives Journals
Summary:
Patients who underwent coronary artery bypass graft surgery and had elevated levels of the cardiac enzymes creatine kinase or troponin in the 24 hours following surgery had an associated intermediate and long-term increased risk of death, according to a new study.

Patients who underwent coronary artery bypass graft surgery and had elevated levels of the cardiac enzymes creatine kinase or troponin in the 24 hours following surgery had an associated intermediate and long-term increased risk of death, according to a study in the February 9 issue of JAMA.

"About 400,000 coronary artery bypass grafting (CABG) procedures are performed annually in the United States, giving public health significance to factors that affect the outcome of these procedures," the authors write. Increases in creatine kinase (CK-MB) or troponin levels following CABG is common, and are an indicator of myocardial necrosis (death of heart muscle cells). Small amounts of necrosis are often regarded as insignificant. However, several small studies have suggested that cardiac enzyme elevation in the 24 hours following CABG surgery is associated with worse prognosis, but a definitive study has not been available, according to background information in the article.

Michael J. Domanski, M.D., of the Mount Sinai Cardiovascular Institute, New York, and colleagues examined the relationship between post-CABG elevation of enzyme markers of myocardial damage and early, intermediate-, and long-term mortality. The researchers analyzed data from randomized clinical trials or registries in which patients underwent CABG surgery and postprocedure biomarker (CK-MB, troponin, or both) and mortality data were collected. For this analysis, the researchers identified 7 studies, which included a total of 18,908 patients. Follow-up varied from 3 months to 5 years.

For each patient, the CK-MB ratio was calculated as the ratio between the peak CK-MB and the upper limit of normal for the participating laboratory of each study. The researchers found that higher ratios were associated with greater risk of death. The 30-day mortality rates by categories of CK-MB ratio were 0.63 percent for 0 to less than 1, 0.86 percent for 1 to less than 2, 0.95 percent for 2 to less than 5, 2.09 percent for 5 to less than 10, 2.78 percent for 10 to less than 20, and 7.06 percent for 20 to 40 or greater. "The model suggests that a CK-MB ratio value of 4 to 5 results in an expected 30-day mortality that is more than double that for a CK-MB ratio of 1. Available troponin data yielded a similar relationship," the authors write.

The researchers also found that of the variables in the model, including CK-MB ratio, age, history of kidney dysfunction, and prior heart attack, the CK-MB ratio was the strongest predictor of death and remained significant even after adjusting for baseline risk factors. This result was strongest at 30 days, but the adjusted association persisted from 30 days to 1 year and a trend was present from 1 year to 5 years. The findings were similar when the troponin ratio, rather than CK-MB ratio, was examined.

"Although enzyme elevations are common following CABG surgery, our data make clear that the long-term prognosis is worse for patients who experience even a small elevation of CK-MB than those who do not experience such a increase," the researchers write.

"These findings may inform the design of future clinical trials with respect to using cardiac markers as an outcome measure following CABG surgery. Although these findings require confirmation in large prospective studies, they suggest that there are clinical implications in terms of long-term prognosis for cardiac enzyme elevations following CABG surgery, particularly among those with very high levels."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Michael J. Domanski, Kenneth Mahaffey, Vic Hasselblad, Sorin J. Brener, Peter K. Smith, Graham Hillis, Milo Engoren, John H. Alexander, Jerrold H. Levy, Bernard R. Chaitman, Samuel Broderick, Michael J. Mack, Karen S. Pieper, Michael E. Farkouh. Association of Myocardial Enzyme Elevation and Survival Following Coronary Artery Bypass Graft Surgery. JAMA, 2011; 305 (6): 585-591 DOI: 10.1001/jama.2011.99

Cite This Page:

JAMA and Archives Journals. "Elevated levels of cardiac biomarkers following CABG surgery associated with increased risk of death." ScienceDaily. ScienceDaily, 9 February 2011. <www.sciencedaily.com/releases/2011/02/110208163955.htm>.
JAMA and Archives Journals. (2011, February 9). Elevated levels of cardiac biomarkers following CABG surgery associated with increased risk of death. ScienceDaily. Retrieved October 20, 2014 from www.sciencedaily.com/releases/2011/02/110208163955.htm
JAMA and Archives Journals. "Elevated levels of cardiac biomarkers following CABG surgery associated with increased risk of death." ScienceDaily. www.sciencedaily.com/releases/2011/02/110208163955.htm (accessed October 20, 2014).

Share This



More Health & Medicine News

Monday, October 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Microneedle Patch Promises Painless Pricks

Microneedle Patch Promises Painless Pricks

Reuters - Innovations Video Online (Oct. 18, 2014) Researchers at The National University of Singapore have invented a new microneedle patch that could offer a faster and less painful delivery of drugs such as insulin and painkillers. Video provided by Reuters
Powered by NewsLook.com
Raw: Nurse Nina Pham Arrives in Maryland

Raw: Nurse Nina Pham Arrives in Maryland

AP (Oct. 17, 2014) The first nurse to be diagnosed with Ebola at a Dallas hospital walked down the stairs of an executive jet into an ambulance at an airport in Frederick, Maryland, on Thursday. Pham will be treated at the National Institutes of Health. (Oct. 16) Video provided by AP
Powered by NewsLook.com
Raw: Cruise Ship Returns to US Over Ebola Fears

Raw: Cruise Ship Returns to US Over Ebola Fears

AP (Oct. 17, 2014) A Caribbean cruise ship carrying a Dallas health care worker who is being monitored for signs of the Ebola virus is heading back to Texas, US, after being refused permission to dock in Cozumel, Mexico. (Oct. 17) Video provided by AP
Powered by NewsLook.com
Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

Spanish Govt: Four Suspected Ebola Cases in Spain Test Negative

AFP (Oct. 17, 2014) All four suspected Ebola cases admitted to hospitals in Spain on Thursday have tested negative for the deadly virus in a first round of tests, the government said Friday. Duration: 00:55 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins