U. Jain et al., SIGNIFICANCE OF ELECTROCARDIOGRAPHIC ST ELEVATION DURING CORONARY-ARTERY BYPASS-SURGERY, Anesthesia and analgesia, 78(4), 1994, pp. 638-643
The aim of this study was to determine the significance of new electro
cardiographic (ECG) ST elevation during coronary artery bypass surgery
. Multilead ECGs were recorded intraoperatively approximately every 3
min on 105 patients. Cases of new ST elevation were divided into ische
mic and those considered to be due to nonischemic causes such as cooli
ng during cardiopulmonary bypass (CPB), defibrillation, new cardiac co
nduction abnormalities, and pericarditis. The myocardial fraction of c
reatine kinase (CK-MB) greater-than-or-equal-to 25 IU/L was considered
to be indicative of myocardial injury. Both patients who had ischemic
ST elevation prior to CPB and all seven patients who had ST elevation
in temporal association with the administration of protamine had peak
CK-MB greater-than-or-equal-to 25 IU/L. One patient with peak CK-MB g
reater-than-or-equal-to 25 IU/L did not have ST elevation and was cons
idered to have injury during CPB. Two of these ten patients had Q wave
myocardial infarctions (MIs). For the detection of patients with peak
CK-MB greater-than-or-equal-to 25 IU/L, the sensitivity of ischemic S
T elevation was 90% and the specificity was 100%. A history of MI prio
r to surgery and a history of Type I diabetes were associated with pea
k CK-MB greater-than-or-equal-to 25 IU/L (P < 0.05).