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Perioperative myocardial infarction associated with coronary artery bypass graft surgery: improved sensitivity in the diagnosis within 6 hours after operation with 99mTc-glucoheptonate myocardial imaging and myocardial-specific isoenzymes.

Abstract
The present study was performed to evaluate scintigraphic imaging with technetium 99m-labeled glucoheptonate and serum enzyme levels of creatine phosphokinase isoenzyme (MB-CPK) in the early diagnosis of perioperative acute myocardial infarction associated with saphenous vein bypass graft operations. Myocardial imaging was done in 27 patients (50% of whom were considered high-risk) before operation and again 5 hours after operation. Four of these patients (15%) had both electrocardiographic and serum MB-CPK evidence of acute myocardial infarction, and all 4 had developed positive postoperative scintigrams. Four other patients had only elevated serum MB-CPK, and scintigrams became positive after operation in 3 of them. In addition, serum MB-CPK 6 hours after operation was 83 +/- 21 mIU/ml (mean +/- standard error of the mean) in patients with positive postoperative scans compared with 24 +/- 5 mIU/ml in those patients with negative postoperative scintigrams (p less than 0.001). Myocardial imaging with 99mTc-glucoheptonate in the perioperative period is rapid, safe, and atraumatic. Furthermore, our results suggest that it is a sensitive method for the early diagnosis of perioperative acute myocardial infarction, and, when imaging is combined with serum MB-CPK isoenzyme analysis, the reliability of the diagnosis of acute myocardial infarction is enhanced even further. Only 1 of the patients who showed perioperative myocardial damage had acute hemodynamic compromise or obvious impairment of recovery in the immediate postoperative period, and the 30-day mortality of the total group was 4% (1 of 27).
AuthorsA J Roberts, J R Combes, J G Jacobstein, D R Alonso, M R Post, V A Subramanian, R M Abel, N Brachfeld, S A Kline, W A Gay Jr
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 27 Issue 1 Pg. 42-8 (Jan 1979) ISSN: 0003-4975 [Print] Netherlands
PMID313189 (Publication Type: Journal Article)
Chemical References
  • Heptoses
  • Isoenzymes
  • Sugar Acids
  • Technetium
  • alpha-glucoheptonic acid
  • Creatine Kinase
Topics
  • Acute Disease
  • Coronary Artery Bypass (adverse effects)
  • Creatine Kinase (blood)
  • Female
  • Heart (diagnostic imaging)
  • Heptoses
  • Humans
  • Isoenzymes (blood)
  • Male
  • Middle Aged
  • Myocardial Infarction (diagnosis, etiology)
  • Postoperative Period
  • Radionuclide Imaging
  • Sugar Acids
  • Technetium
  • Time Factors

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