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From JAMA |

Enzyme Elevation After Coronary Bypass Surgery Cause or Effect?

Arvind K. Agnihotri, MD; Thoralf M. Sundt, MD
Arch Surg. 2011;146(8):983-984. doi:10.1001/archsurg.2011.193.
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Domanski and colleagues1 address an important issue in their article; coronary bypass surgery is perhaps the most studied operation in medicine, beginning with the prospective randomized trial2 of coronary artery bypass surgery (ie, the coronary artery surgery study) and continuing even today with intense scrutiny of perioperative outcomes both in the scientific literature and in the public press. Their study1 aims at understanding the implications of periprocedural enzyme (CK-MB and troponin) release. Their analysis of data from 7 selected studies furthers our knowledge of a previously identified association between postoperative myocardial enzyme elevation and mortality. They find that the association is significant across a broad range of enzyme elevations, including only modest levels, and that the association persists well past the immediate postoperative period. With almost half a million coronary artery bypass grafting procedures performed each year in the United States alone, the clinical implications are profound.

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