Implementation of the Third Universal Definition of Myocardial Infarction After Coronary Artery Bypass Grafting: A Survey Study in Western Europe

Abstract

BackgroundDiagnosing a postoperative myocardial infarction in patients undergoing coronary artery bypass grafting is challenging, as the normally used criteria are more difficult to interpret. The rate of implementation of the consensus‐based new diagnostic criteria for postoperative myocardial infarction proposed by the third universal definition of myocardial infarction is unknown. Therefore, the primary objective of this study was to address the implementation of the third universal definition of postoperative myocardial infarction following coronary artery bypass grafting.Methods and ResultsWe conducted a web‐based survey by sending 4 waves of invitations via e‐mail to cardiothoracic surgeons in 12 Western European countries. Of the 302 participating cardiothoracic specialists, from 182 different centers, 213 (71%) were aware that troponin is the preferred biomarker and 112 (37%) knew that using a cut‐off level of >10 times the 99th percentile is recommended. Overall, 90 (30%) participants (strongly) agreed with implementation of this cut‐off level in their clinical practice. Troponin was used in clinical practice by 149 (49%) of the participants. In total, 117 (89%) of the 131 participants with a local guideline confirmed ECG changes as a diagnostic criterion in that guideline. ST segmental changes (75, 64%) were used more often for diagnosing postoperative myocardial infarction than Q waves (64, 55%) or new left bundle branch blocks (34, 29%).ConclusionsCardiac biomarkers and ECG changes were not used in concordance with the third universal definition, and only a minority had a positive attitude toward implementation of the proposed cut‐off level for troponin in their clinical practice.

Electrocardiographic parameters effectively predict ventricular tachycardia/fibrillation in acute phase and abnormal cardiac function in chronic phase of ST‐segment elevation myocardial infarction

“…Blood levels of creatine kinase-MB (CK-MB, normal range: < 23 u/L), cardiac troponin-T (cTnT, normal range: < 0.03 ng/mL), serum potassium (normal range: 3.5-5.5 mmol/L), and N-terminal pro-brain natriuretic peptide (NT-proBNP, normal range: < 300 pg/mL) were assessed in the clinical laboratory of our hospital. STEMI was diagnosed based on defined criteria, 16,17 including a history of angina pectoris and characteristic changes of ECG, CK-MB, and cTnT above the 99th percentile of the upper reference limit. Patients were excluded with the following conditions as in cases with PVC or VT/VF unrelated to STEMI: (1) ion channelopathy, e.g., Brugada and long-QT syndromes, family history of sudden cardiac death, or any reason of previous implantable cardioverter defibrillator (ICDs); (2) systemic disease that tends to elicit arrhythmia, e.g., hyperthyroidism and pheochromocytoma; (3) previously documented PVC and VT/VF before STEMI; (4) long-term treatment with antiarrhythmic agents (e.g., amiodarone and propafenone); and (5) branch bundle block which could confound the analysis of ECG parameters.…”

Proximity Ligation Assay Detection of Protein–DNA Interactions—Is There a Link between Heme Oxygenase-1 and G-quadruplexes?

“…A labile heme pool, which is available for heme signaling, is far less abundant and buffered at a concentration of below 1 μmol/L [ 26 ]. The labile fraction may increase after extracellular heme overload, enhanced heme synthesis, accelerated hemoprotein breakdown under oxidative conditions, or impaired heme degradation [ 25 , 27 ]. Free heme excess is known to enhance the generation of reactive oxygen species (ROS) and induces the oxidative stress that may cause damage primarily to lipid membranes, but also to proteins and nucleic acids [ 25 ].…”

Clinical Relevance of Troponin T Profile Following Cardiac Surgery

“…As a consequence, the use of cut-off values can currently not be implemented in routine practice (16). Recent guidelines on the diagnosis of perioperative myocardial infarction (PMI) have even warned about misinterpretation (17, 18).…”