Correlation between Postoperative Creatine Kinase-MB and In-hospital Death for Congenital Heart Disease Infants Weighing Less Than 15 kg_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZOULi-hua ¹ , ZHANGHao ² ,  LIUJin-ping ¹ , WUShu-bin ¹ , WANGTian ¹

1. Department of Cardiopulmonary Bypass, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P. R. China;
2. Department of Pediatric Cardiac Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

LIUJin-ping, Email: jinpingfw@hotmail.com

Keywords：

Cardiac surgery; Creatine kinase-MB; Death; Low-body weight

DOI：

10.7507/1007-4848.20150086

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Objective To analyze the influencing and prognostic factors for in-hospital death of creatine kinase-MB after cardiac surgery for congenital heart disease in pediatric. Methods Clinical data of 708 children with body weight less than 15 kg who underwent cardiac surgery at Fu Wai Hospital between January 2012 and December 2013 were retrospectively analyzed. There were 269 males (38.0%) and 439 females (62.0%). The postoperative maximum CK-MB was calculated for analysis and patients were devided into three groups:a group A (CK-MB≤25 IU/L), a group B (25 IU/L < CK-MB≤125 IU/L) and a group C (CK-MB > 125 IU/L). Results Postoperative CK-MB level was independently associated with cyanotic congenital heart disease (P=0.002), the aorta cross clamp (P=0.030), the cardiopulmonary bypass time (P=0.002), the cross clamp time (P=0.016), the re-establish of bypass (P < 0.001), deep hypothermic circulatory arrest (P=0.024). There was statistical difference in mortality between the 3 groups (P < 0.001). The receiver operating characteristic curve showed that CK-MB has predictive value for in-hospital death (P < 0.001) and the cutoff value is 168.5 IU/L, with a sensitivity of 54.2%, specificity of 90.8%, positive predictive value of 17.3% and negative predictive value of 98.4%. CK-MB level above 168.5 IU/L was an independent risk factor for in-hospital death (OR=6.364, P < 0.001). Conclusion Elevation of CK-MB after cardiac surgery is independently influenced by several variables. Pediatric with major CK-MB elevation has high risk of in-hospital death.

Citation： ZOULi-hua, ZHANGHao, LIUJin-ping, WUShu-bin, WANGTian. Correlation between Postoperative Creatine Kinase-MB and In-hospital Death for Congenital Heart Disease Infants Weighing Less Than 15 kg. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 311-316. doi: 10.7507/1007-4848.20150086 Copy

1.	凌庆, 汪涛, 赵萍, 等.新生儿复杂先天性心脏病的外科治疗.中国胸心血管外科临床杂志, 2005, 12(3):155-157.
2.	Domanski MJ, Mahaffey K, Hasselblad V, et al.Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery.JAMA, 2011, 305(6):585-591.
3.	Costa MA, Carere RG, Lichtenstein SV, et al.Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the Arterial Revascularization Therapies Study (ARTS).Circulation, 2001, 104(22):2689-2693.
4.	Califf RM, Abdelmeguid AE, Kuntz RE, et al.Myonecrosis after revascularization procedures.J Am Coll Cardiol, 1998, 31(2):241-251.
5.	Jenkins KJ, Gauvreau K, Newburger JW, et al.Consensus-based method for risk adjustment for surgery for congenital heart disease.J Thorac Cardiovasc Surg, 2002, 123(1):110-118.
6.	Bolling K, Kronon M, Allen BS, et al.Myocardial protection in normal and hypoxically stressed neonatal hearts:the superiority of blood versus crystalloid cardioplegia.J thoracic cardiovasc surg, 1997, 113(6):994-1003.
7.	Morita K.Surgical reoxygenation injury of the myocardium in cyanotic patients:clinical relevance and therapeutic strategies by normoxic management during cardiopulmonary bypass.Gen Thorac Cardiovasc Surg, 2012, 60(9):549-556.
8.	Boucek RJ Jr, Kasselberg AG, Boerth RC, et al.Myocardial injury in infants with congenital heart disease:evaluation by creatine kinase MB isoenzyme analysis.Am J Cardiol, 1982, 50(1):129-135.
9.	Modi P, Suleiman MS, Reeves BC, et al.Basal metabolic state of hearts of patients with congenital heart disease:the effects of cyanosis, age, and pathology.Ann Thorac Surg, 2004, 78(5):1710-1716.
10.	Paparella D, Yau TM, Young E.Cardiopulmonary bypass induced inflammation:pathophysiology and treatment.An update.Eur J Cardiothorac Surg, 2002, 21(2):232-244.
11.	Zahler S, Massoudy P, Hartl H, et al.Acute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass.Cardiovasc Res, 1999, 41(3):722-730.
12.	Baufreton C, Intrator L, Jansen PG, et al.Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps.Ann Thorac Surg, 1999, 67(4):972-977.
13.	Gulielmos V, Menschikowski M, Dill H, et al.Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting-a prospective randomized comparison of the conventional and three minimally invasive surgical techniques.Eur J Cardiothorac Surg, 2000, 18(5):594-601.
14.	Hasegawa T, Yamaguchi M, Yoshimura N, et al.The dependence of myocardial damage on age and ischemic time in pediatric cardiac surgery.J Thorac Cardiovasc Surg, 2005, 129(1):192-198.
15.	Clermont G, Vergely C, Jazayeri S, et al.Systemic free radical activation is a major event involved in myocardial oxidative stress related to cardiopulmonary bypass.Anesthesiology, 2002, 96(1):80-87.
16.	Mildh LH, Pettilä V, Sairanen HI, et al.Cardiac troponin T levels for risk stratification in pediatric open heart surgery.Ann Thorac Surg, 2006, 82(5):1643-1648.
17.	Apple FS.Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB.Clin Chim Acta, 1999, 284(2):151-159.
18.	Saenger AK, Jaffe AS.Requiem for a heavyweight:the demise of creatine kinase-MB.Circulation, 2008, 118(21):2200-2206.

1. 凌庆, 汪涛, 赵萍, 等.新生儿复杂先天性心脏病的外科治疗.中国胸心血管外科临床杂志, 2005, 12(3):155-157.
2. Domanski MJ, Mahaffey K, Hasselblad V, et al.Association of myocardial enzyme elevation and survival following coronary artery bypass graft surgery.JAMA, 2011, 305(6):585-591.
3. Costa MA, Carere RG, Lichtenstein SV, et al.Incidence, predictors, and significance of abnormal cardiac enzyme rise in patients treated with bypass surgery in the Arterial Revascularization Therapies Study (ARTS).Circulation, 2001, 104(22):2689-2693.
4. Califf RM, Abdelmeguid AE, Kuntz RE, et al.Myonecrosis after revascularization procedures.J Am Coll Cardiol, 1998, 31(2):241-251.
5. Jenkins KJ, Gauvreau K, Newburger JW, et al.Consensus-based method for risk adjustment for surgery for congenital heart disease.J Thorac Cardiovasc Surg, 2002, 123(1):110-118.
6. Bolling K, Kronon M, Allen BS, et al.Myocardial protection in normal and hypoxically stressed neonatal hearts:the superiority of blood versus crystalloid cardioplegia.J thoracic cardiovasc surg, 1997, 113(6):994-1003.
7. Morita K.Surgical reoxygenation injury of the myocardium in cyanotic patients:clinical relevance and therapeutic strategies by normoxic management during cardiopulmonary bypass.Gen Thorac Cardiovasc Surg, 2012, 60(9):549-556.
8. Boucek RJ Jr, Kasselberg AG, Boerth RC, et al.Myocardial injury in infants with congenital heart disease:evaluation by creatine kinase MB isoenzyme analysis.Am J Cardiol, 1982, 50(1):129-135.
9. Modi P, Suleiman MS, Reeves BC, et al.Basal metabolic state of hearts of patients with congenital heart disease:the effects of cyanosis, age, and pathology.Ann Thorac Surg, 2004, 78(5):1710-1716.
10. Paparella D, Yau TM, Young E.Cardiopulmonary bypass induced inflammation:pathophysiology and treatment.An update.Eur J Cardiothorac Surg, 2002, 21(2):232-244.
11. Zahler S, Massoudy P, Hartl H, et al.Acute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass.Cardiovasc Res, 1999, 41(3):722-730.
12. Baufreton C, Intrator L, Jansen PG, et al.Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps.Ann Thorac Surg, 1999, 67(4):972-977.
13. Gulielmos V, Menschikowski M, Dill H, et al.Interleukin-1, interleukin-6 and myocardial enzyme response after coronary artery bypass grafting-a prospective randomized comparison of the conventional and three minimally invasive surgical techniques.Eur J Cardiothorac Surg, 2000, 18(5):594-601.
14. Hasegawa T, Yamaguchi M, Yoshimura N, et al.The dependence of myocardial damage on age and ischemic time in pediatric cardiac surgery.J Thorac Cardiovasc Surg, 2005, 129(1):192-198.
15. Clermont G, Vergely C, Jazayeri S, et al.Systemic free radical activation is a major event involved in myocardial oxidative stress related to cardiopulmonary bypass.Anesthesiology, 2002, 96(1):80-87.
16. Mildh LH, Pettilä V, Sairanen HI, et al.Cardiac troponin T levels for risk stratification in pediatric open heart surgery.Ann Thorac Surg, 2006, 82(5):1643-1648.
17. Apple FS.Tissue specificity of cardiac troponin I, cardiac troponin T and creatine kinase-MB.Clin Chim Acta, 1999, 284(2):151-159.
18. Saenger AK, Jaffe AS.Requiem for a heavyweight:the demise of creatine kinase-MB.Circulation, 2008, 118(21):2200-2206.

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Correlation between Postoperative Creatine Kinase-MB and In-hospital Death for Congenital Heart Disease Infants Weighing Less Than 15 kg

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