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Abstract: Poster Presentations |

POSTOPERATIVE CREATINE KINASE MB LEVEL IS ASSOCIATED WITH IN-HOSPITAL MORTALITY AFTER CORONARY SURGERY FREE TO VIEW

Li Zhang, MD; Kathleen Petro, MD; Peter Hill, MD*; Elizabeth Haile, MS; Jorge Garcia, MD; Ammar Bafi, MD; Steven Boyce, MD; Paul Corso, MD
Author and Funding Information

Washington Hospital Center, Washington, DC


Chest


Chest. 2005;128(4_MeetingAbstracts):266S-c-267S. doi:10.1378/chest.128.4_MeetingAbstracts.266S-c
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Abstract

PURPOSE:  Cardiac enzymes are widely used for evaluation of perioperative myocardial injury. This study was to investigate the potential relationship between postoperative creatine kinase MB (CKMB) level and clinical outcomes in the patients after isolated coronary artery bypass grafting (CABG).

METHODS:  Seven thousand and ninety-five patients who underwent isolated CABG between January 2000 and June 2004 at the Washington Hospital Center were included in this study. CKMB level was measured in the morning of the first post-operative day. Three groups were created according to CKMB level: Group I: CKMB ≤ 5.2 ng/ml; Group II: 5.2 < CKMB ≤ 13 ng/ml; Group III: CKMB > 13 ng/ml.

RESULTS:  CKMB level above normal upper limit was relatively common after isolated CABG. Patient with CKMB > 13 ng/ml (5 times of normal upper limit) were more frequently those with history of myocardial infarction (MI), left main disease and poor left ventricular function (EF < 35%), preoperative IABP support, having a repeated procedure (Table 1). Difference of in-hospital mortality, morbidities (stroke, MI) and length of hospital stay was statistically significant between the three groups (Table 2). Based on multivariable analysis, patients with CKMB > 13 ng/ml were more likely at risk for isolated CABG than those with CKMB ≤ 5.2 ng/ml (2 times of normal upper limit), in terms of in-hospital mortality, postoperative MI, and prolonged hospitalization (p < 0.01).

CONCLUSION:  This is the largest retrospective study on the prognostic value of postoperative CKMB level in patients undergoing CABG. We conclude that an extremely high CKMB level is an indicator of in-hospital mortality and morbidities.

CLINICAL IMPLICATIONS:  CKMB levels should be measured routinely after CABG, to identify high-risk patients. Table 1.

Univariate Comparisons of Demographic and Clinical Characteristics Between the Three Groups.

Group I (CKMB <5.2 ng/ml) (N=3,531)Group II (5.2<CKMB <13ng/ml) (N=2,197)Group III (CKMB>13 ng/ml) (N=1,367)p valueAge (y)64.4±10.664.6±10.665.1±10.70.05*Female Gender1020 (28.9)583 (26.5)434 (31.8)0.23Diabetes1308 (37.0)783 (35.6)482 (35.3)0.19Hypertension2465 (69.8)1587 (72.2)977 (71.5)0.12Congestive Heart Failure281 (8.0)215 (9.8)98 (7.2)0.92Myocardial Infarction within 24 hrs6 (0.2)11 (0.5)28 (2.1)<0.01History of Myocardial Infarction1259 (35.7)891 (40.6)633 (46.3)<0.01Previous CVA4 (0.1)7 (0.3)1 (0.1)0.81Carotid Artery Disease60 (1.7)32 (1.5)28 (2.1)0.58Renal Failure123 (3.5)87 (4.0)62 (4.5)0.08Preoperative Hemodialysis62 (1.8)44 (2.0)35 (2.6)0.08COPD18 (0.5)20 (0.9)9 (0.7)0.31Left Main Disease458 (13.0)336 (15.3)224 (16.4)<0.01Ejection Fraction<0.01*> 45%1951 (55.3)1055 (48.0)579 (42.4)35% - 45%945 (26.8)623 (28.4)445 (32.6)25% - 34%506 (14.3)388 (17.7)276 (20.2)≤ 25%129 (3.7)131 (6.0)67 (4.9)Preoperative IABP Insertion38 (1.1)42 (1.9)33 (2.4)<0.01Peripheral Vascular Disease397 (11.2)288 (13.1)188 (13.8)0.01Parsonnet Risk Score11.0 (6.0–17.0)12.0 (6.5–19.0)13.5 (9.0–20.5)<0.01*Northern New England CVA Risk Score1.1 (0.7–1.9)1.5 (0.7–2.8)1.5 (0.7–2.8)<0.01*Off-pump CABG2864 (81.1)798 (36.3)545 (39.9)<0.01Redo CABG82 (2.3)110 (5.0)122 (8.9)<0.01Urgent CABG763 (21.6)559 (25.4)405 (29.6)<0.01Number of Grafts<0.01*1221 (6.3)42 (1.9)32 (2.3)2704 (19.9)192 (8.7)147 (10.8)31254 (35.5)656 (29.9)391 (28.6)4924 (26.2)793 (36.1)505 (36.9)5357 (10.1)414 (18.8)241 (17.6)657 (1.6)81 (3.7)41 (3.0)713 (0.4)17 (0.8)9 (0.7)81 (0.03)1 (0.1)1 (0.1)90 (0.0)1 (0.1)0 (0.0)*

Values are expressed as N (%), mean ± std or median (25th –75th percentile).

Table 2.

Univariate Comparisons of Postoperative Outcomes Between the Three Groups.

Group I (CKMB <5.2 ng/ml) (N = 3,531)Group II (5.2 <CKMB <13 ng/ml) (N = 2,197)Group III (CKMB >13 ng/ml) (N = 1,367)p ValueIn-Hospital Operative Mortality13 (0.4)27 (1.2)24 (1.8)<0.01Stroke46 (1.3)40 (1.8)36 (2.6)<0.01Myocardial Infarction13 (0.4)36 (1.6)90 (6.6)<0.01Prolonged Ventilation126 (3.6)142 (6.5)146 (10.7)<0.01Need of Hemodialysis3 (0.1)6 (0.3)3 (0.2)0.17Length of Hospital Stay (day)4 (4–6)5 (4–7)5 (4–7)<0.01**

Values are expressed as N (%) or median (25th –75th percentile).

DISCLOSURE:  Peter Hill, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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