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DOI: 10.1055/s-0030-1269022
Ischemia-modified Albumin in coronary bypass surgery – a supersensitive marker for myocardial injury
Objectives: Ischemia-modified Albumin (IMA) is established as a marker for ischemia tissues especially in PCI patients. In order to determine the degree of myocardial injury during on-pump, versus off-pump coronary bypass grafting, the perioperative alterations of IMA levels have been investigated.
Methods: 55 consecutive elective coronary bypass patients undergoing CABG applying a minimized extracorporeal circulation (MECC) (n=28) or OPCAB (n=27) were included into this study. Blood samples were taken preoperatively, and 1h, 6h, 12h, 24h and 5d after surgery. IMA levels were quantified using the albumin-cobalt-binding assay and correlated to corresponding creatine kinase (CK), CK-MB and troponin T (TnT) serum levels.
Results: In both groups IMA was significantly elevated postoperatively, peaking at 12h and dropping towards base line levels at 24h. Based on significantly elevated CK, CK-MB, TnT and IMA levels the myocardial injury was more severe in the MECC group. Notably, IMA levels differed already significantly between both groups 1h postoperatively, whereas differences in CK, CK-MB and TnT levels were delayed until 6h. IMA: 1h (p=0.004), 6h (p=0.009) and 12h (p=0.003). TnT: 1h (p=0.284), 6h (p=0.019), 12h (p<0.001). However, the observed myocardial injury did not reach clinical significance, since all patients showed a smooth postoperative course.
Conclusions: IMA can serve as an innovative marker for ischemia. It indicates ischemic myocardial injury immediately after coronary bypass surgery, demonstrating its superior sensitivity over well established methods.