Diagnostic and prognostic significance of electrocardiographic and CPK isoenzyme changes following coronary bypass surgery: correlation with findings at one year.
The incidence of ECG (14 per cent) indication of acute myocardial infarction complicating coronary artery bypass surgery is documented, corroborating the findings of prior series. An additional 32 per cent of patients had appearance of myocardial specific CPK-MB in serum during the immediate postoperative period. All patients surviving to 1 year following surgery (93 of 103) were asked to return for repeat cardiac catheterization to determine the presence and extent of interim ventricular contraction abnormalities. Sixty-five (70 per cent) of the group returned for evaluation. Preoperative and 1 year postoperative left ventriculograms were compared to determine if new contraction abnormalities would confirm the specificity of perioperative QRS and isoenzyme changes, and if the absence of new abnormalities would confirm their sensitivity. The majority of patients (65 per cent) had new areas of asynergy. However, 73 per cent of these were confined to the apex and thus could have been produced by the vent employed during cardiopulmonary bypass. QRS changes were 100 per cent specific and CPK-MB appearance was 78 per cent specific but they were only 20 and 54 per cent sensitive, respectively. Indeed, 46 per cent of those with new asynergy which was non apical had neither QRS change nor CPK-MB appearance. Thus QRS changes were always--and CPK-MB appearance was usually--associated with new asynergy but, in addition, many patients with no perioperative indication of infarction developed new areas of left ventricular contraction abnormality within the first postoperative year.
Warren, SG; Wagner, GS; Bethea, CF; Roe, CR; Oldham, HN; Kong, Y
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