Original articleIntermittent Cardiac Troponin-I Screening is an Effective Means of Surveillance for a Perioperative Myocardial Infarction
Section snippets
Methods
After written informed consent, 467 patients with either known coronary artery disease requiring a noncardiac surgical procedure or patients undergoing major vascular surgery necessitating a minimum of a 24-hour admission participated in this study from July 1996 through October 1999. A history of coronary artery disease was defined as a documented history of MI by electrocardiography or enzyme determination, angina pectoris requiring treatment, or a positive cardiac stress test. Major vascular
Results
A total of 502 patients were enrolled in the study, 422 from the Johns Hopkins Hospital (JHH) and 80 from Yale-New Haven Hospital (YNHH). Nine JHH patients and 16 YNHH patients were excluded from the study sample if they met any or all of the following criteria: their surgical procedure was cancelled after enrollment, patient withdrawal, or cardiac surgery within 24 hours of the case of interest. Ultimately, 10 additional study patients (5 from JHH and 5 from YNHH) were excluded from the data
Discussion
The present results indicate that cTn-I ≥2.6 ng/mL detected myocardial injury with greater specificity than absolute CK-MB ≥8 ng/mL (98% compared with 82%, respectively). Although elevations of CK-MB ≥8 ng/mL detected a greater number of patients with either ECG changes or symptoms, it was associated with a much higher incidence of false positives (53% v 15% for cTn-I ≥2.6 ng/mL). Several studies have documented the nonspecific release of CK-MB after vascular surgery, which may account for the
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2017, Journal of Clinical NeuroscienceCitation Excerpt :Immediately post-operative TnI elevation occurs in approximately up to 90% of such cases by 24 h [5]. In consequence, some have suggested immediately post-operative TnI monitoring as a “standard of care” [1] to diagnose post-operative myocardial complications, to identify those at increased risk for postoperative mortality, and to institute regimes to offset subsequent myocardial injury [1–6]. Surprisingly, however, few studies have also measured pre-operative baseline TnI with which to validate the veracity of post-operative TnI elevations [5].
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Supported by a grant, reagents, and equipment from Dade Behring, Inc., Deerfield, IL, and in part by GCRC/NIH grant no. M01-RR00052 and the Johns Hopkins Department of Anesthesiology and Critical Care Medicine clinical research grant.