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Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization.

Publication ,  Journal Article
Hughes, GC; Landolfo, KP; Lowe, JE; Coleman, RB; Donovan, CL
Published in: Am Heart J
June 1999

BACKGROUND: Clinical improvement after transmyocardial laser revascularization (TMR) is typically delayed, and patients therefore remain at risk for ischemic events after the procedure. The purpose of this study was to define the range of creatine phosphokinase (CPK) and CPK-MB enzyme elevation after TMR and to assess the incidence of early postoperative ischemic events. METHODS: Twenty-one patients undergoing isolated TMR were evaluated for 48 hours after surgery with serial CPK and CPK-MB enzymes and 12-lead electrocardiograms for evidence of myocardial ischemia or injury. Clinically evident postoperative ischemic events including angina pectoris, myocardial infarction (MI), and cardiac death were recorded as well. RESULTS: Eleven patients (52.4%) had ischemic electrocardiographic changes in the first 48 hours after TMR. Ischemia was clinically silent in 7 (63.6%) of these 11 patients. Cardiac death occurred in 1 patient (4.8%) as a result of acute MI. Nonfatal MI occurred in an additional 4 patients (19.0%). Of the 5 patients with MI, 4 had angina pectoris versus no angina in the 16 patients without MI (P =.02). All patients had elevated CPK and CPK-MB levels after TMR: however, peak CPK (P =.02) and CPK-MB (P =. 005) levels were significantly higher for patients suffering postoperative MI compared with those without MI. CONCLUSIONS: Transient ischemia occurs frequently after TMR and is clinically silent in the majority of patients. Patients with postoperative MI are more likely to have symptomatic ischemia as well as significant cardiac enzyme elevation. The combination of 12-lead electrocardiogram and cardiac enzymes appears to have significant merit for the diagnosis of myocardial ischemia and infarction after TMR. These studies should be obtained in all patients undergoing TMR for the first 48 hours after surgery.

Duke Scholars

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

June 1999

Volume

137

Issue

6

Start / End Page

1163 / 1168

Location

United States

Related Subject Headings

  • Time Factors
  • Statistics, Nonparametric
  • Postoperative Complications
  • Myocardial Revascularization
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Laser Therapy
  • Isoenzymes
  • Incidence
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hughes, G. C., Landolfo, K. P., Lowe, J. E., Coleman, R. B., & Donovan, C. L. (1999). Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization. Am Heart J, 137(6), 1163–1168. https://doi.org/10.1016/s0002-8703(99)70377-7
Hughes, G. C., K. P. Landolfo, J. E. Lowe, R. B. Coleman, and C. L. Donovan. “Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization.Am Heart J 137, no. 6 (June 1999): 1163–68. https://doi.org/10.1016/s0002-8703(99)70377-7.
Hughes GC, Landolfo KP, Lowe JE, Coleman RB, Donovan CL. Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization. Am Heart J. 1999 Jun;137(6):1163–8.
Hughes, G. C., et al. “Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization.Am Heart J, vol. 137, no. 6, June 1999, pp. 1163–68. Pubmed, doi:10.1016/s0002-8703(99)70377-7.
Hughes GC, Landolfo KP, Lowe JE, Coleman RB, Donovan CL. Diagnosis, incidence, and clinical significance of early postoperative ischemia after transmyocardial laser revascularization. Am Heart J. 1999 Jun;137(6):1163–1168.
Journal cover image

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

June 1999

Volume

137

Issue

6

Start / End Page

1163 / 1168

Location

United States

Related Subject Headings

  • Time Factors
  • Statistics, Nonparametric
  • Postoperative Complications
  • Myocardial Revascularization
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Laser Therapy
  • Isoenzymes
  • Incidence