2. Academic Validation
  3. Modeling creatine-kinase MB concentrations following coronary artery bypass grafting

Modeling creatine-kinase MB concentrations following coronary artery bypass grafting

  • J Thorac Cardiovasc Surg. 2024 Aug 21:S0022-5223(24)00703-7. doi: 10.1016/j.jtcvs.2024.08.019.
Jamie L Romeo 1,  Pieter A Vriesendorp 2,  Kim Gerritsen 3,  Musafir Nader 4,  Edris Mahtab 4,  Jos G Maessen 5,  Arnoud W J Van't Hof 6,  Can Gollmann-Tepeköylü 7,  Frank van Rosmalen 8,  Iwan C C van der Horst 8,  Alma M A Mingels 9,  Samuel Heuts 5
Affiliations

Affiliations

  • 1 Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands. Electronic address: jamieromeo@live.nl.
  • 2 Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, University Medical Center, Maastricht University, Maastricht, The Netherlands.
  • 3 Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands.
  • 4 Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
  • 5 Department of Cardiothoracic Surgery, University Medical Center, Maastricht University, Maastricht, The Netherlands; Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands.
  • 6 Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands.
  • 7 Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
  • 8 Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Department of Intensive Care Medicine, University Medical Center, Maastricht University, Maastricht, The Netherlands.
  • 9 Cardiovascular Research Institute (CARIM), University Medical Center, Maastricht University, Maastricht, The Netherlands; Central Diagnostic Laboratory, University Medical Center, Maastricht University, Maastricht, The Netherlands.
PMID: 39173711 DOI: 10.1016/j.jtcvs.2024.08.019
Abstract

Background: An increase in cardiac biomarkers is a prerequisite for diagnosing periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG). Early-phase risk detection may be aided by modeling time-dependent serum creatine kinase-MB (CK-MB) concentrations. This study aimed to model the kinetics of CK-MB while identifying its influencing factors.

Methods: Patients who underwent elective CABG and had CK-MB measurements within 72 hours postoperatively were included. The primary outcome was the modeled post hoc kinetics of CK-MB in patients without potential PMI. These patients were defined as having no potential PMI based on the absence of ischemic electrocardiographic abnormalities, imaging abnormalities, in-hospital cardiac arrest, mortality, or postoperative unplanned catheterization. A web-based application was created using mixed-effect modeling to provide an interactive and individualized result.

Results: A total of 1589 CK-MB measurements from 635 patients who underwent elective isolated CABG were available for analysis. Of these, 609 patients (96%) had no potential PMI and 26 (4%) had potential PMI. Male sex, aortic cross-clamp time, and cardioplegia type significantly impacted CK-MB concentrations. The diagnostic accuracy of the model had an area under the receiver operating characteristic curve of 82.8% (95% confidence interval, 72.6%-90.2%). A threshold of 7 μg/L yielded a sensitivity of 94% and a specificity of 80% (positive predictive value, 17%; negative predictive value, 99%) for excluding potential PMI in our study population.

Conclusions: CK-MB release after CABG depends on the timing of measurement, patient sex, aortic cross-clamp time, and cardioplegia type. The model (available at https://www.cardiomarker.com/ckmb) can be validated, reproduced, refined, and applied to other biomarkers.

Keywords

MB isoenzyme of creatine kinase (CK-MB); cardiac biomarkers; coronary artery bypass grafting; mixed modeling; periprocedural myocardial infarction; risk model.

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