The relationship between ASAT, CKMB, troponin-T and mortality after cardiac surgery.

Abstract

Objective: To investigate the relationship between ASAT, CKMB, troponin-T and mortality after cardiac surgery.

Design: ASAT, CKMB and TnT were analysed in 116 patients. Correlation, sensitivity, specificity and predictive values for permanent myocardial injury (defined as TnT > or = 2.0 microg/l postoperative day four) were calculated. In the second part our clinical protocol (ASAT on postoperative day 1 and TnT on day 3-4 in patients with ASAT above 2.5 microkat/l) was evaluated. Mortality was compared between patients with ASAT < 2.5 microkat/l (ASAT-), 2. ASAT > or = 2.5 microkat/l and TnT < 2.0 microg/l (ASAT+/TnT-) and 3. ASAT > or = 2.5 microkat/l and TnT > or = 2.0 microg/l (ASAT+/TnT+).

Results: Both ASAT and CKMB had irrespectively of cut-off level, low positive and high negative predictive value of permanent myocardial injury. Early and mid-term mortality did not differ significantly between ASAT- and ASAT+/TnT- patients.

Conclusions: ASAT and CKMB can be used to exclude but not to diagnose permanent myocardial injury after cardiac surgery. Increased postoperative ASAT in the absence of increased TnT is not associated with worse clinical outcome than after normal postoperative ASAT.