<p>We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated. </p><p>TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (</≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes.</p><p>We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis. </p><p>Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.</p>

Hjärt-kärl sjukdom är den vanligaste dödsorsaken i västvärlden. Samtidigt som antalet patienter med hjärtinfarkt har minskat, har antalet patienter med instabil kranskärlsjukdom d.v.s. svår kärlkramp ökat påtagligt. Diagnosen är nu den vanligaste orsaken till vård på hjärtinfarktavdelningar i Sverige. Modern behandling av instabil kranskärlssjukdom består av en kombination av läkemedel för att minska blodproppsbildning och avlasta hjärtarbetet samt, i de flesta fall, s.k. ballongvidning eller operation av hjärtats kranskärl. Trots stora behandlingsframsteg är risken för hjärtinfarkt och död hög, såväl på kort som lång sikt. Det finns därför ett stort behov av ytterligare förbättrad behandling utan att samtidigt erhålla oacceptabelt hög risk för allvarliga biverkningar. För att erbjuda en effektiv behandling till patienter med hög risk och samtidigt undvika dyr och potentiellt riskfylld behandling till patienter med låg risk behövs också bättre instrument för tidig riskbedömning. Syftet med avhandlingen var att undersöka en stor grupp patienter med instabil kranskärlssjukdom avseende säkerhet och effektivitet av en behandlingskombination av två moderna blodproppshämmande läkemedel, dalteparin och abciximab (ca 1000 patienter). Syftet var också att studera hur denna behandling påverkar system för inflammation och koagulation (ca 400 patienter). Dessutom ville vi värdera hur blodnivåer av markörer för inflammation, hjärtmuskelskada och nedsatt hjärtfunktion kan förutsäga risken för framtida komplikationer (ca 7000 patienter). Tillägg av abciximab till dalteparin minskade inte risken för dödsfall eller hjärtinfarkt inom trettio dagar. Däremot ökade antalet blödningskomplikationer. Totala antalet blödningar var emellertid relativt lågt och behandlingen syntes vara lika säker som kombinationen av abciximab och det internationellt mycket använda blodproppshämmande medlet heparin. Trots den kraftfulla behandlingskombinationen skedde en samtidig aktivering av system för såväl inflammation som koagulation. Detta kan vara en orsak till den observerade avsaknaden av behandlingseffekt av abciximab. Att hindra denna aktivering skulle samtidigt kunna innebära möjligheter för nya behandlingsstrategier. Förhöjda nivåer av markörer för hjärtmuskelskada (troponin T), inflammation (CRP), nedsatt hjärtfunktion (proBNP) eller nedsatt njurfunktion (kreatininclearance) ökade risken för dödlig utgång både på kort och lång sikt, oberoende av andra riskfaktorer. En kombination av två av dessa markörer gav den högsta risken för dödlig utgång. Således dog endast 0.3 % av patienter med låga nivåer av proBNP och normal njurfunktion inom ett år, jämfört med 25.7 % av patienter med höga nivåer av proBNP och nedsatt njurfunktion. Förhöjda nivåer av troponin T eller nedsatt kreatininclearance (men inte av CRP eller proBNP) ökade dessutom risken för hjärtinfarkt. Resultaten i avhandlingsarbetet har givit kliniskt tillämpbar kunskap om hur kärlkrampspatienter med hög respektive låg risk kan selekteras tidigt efter inkomst till sjukhus och ny kunskap om behandlingseffekt av abciximab och dalteparin. Resultaten har redovisats på internationella kongresser och i högt rankade medicinska tidskrifter och har citerats i europeiska och amerikanska ”guidelines” för behandling av instabil kranskärlssjukdom. / Patients with unstable coronary artery disease (CAD) have an increased risk of subsequent myocardial infarction and death. This study evaluated the safety and efficacy of treatment with glycoprotein IIb/IIIa inhibition in addition to aspirin, low molecular-weight heparin and its influence on coagulation and inflammation. Also, early and differentiated risk assessment utilising markers of inflammation, myocardial damage and dysfunction were evaluated. The Global Utilisation of Strategies To open Occluded arteries- IV (GUSTO-IV) trial randomised 7800 patients with unstable CAD to 24 or 48 hours infusion of abciximab or placebo in addition to routine treatment with aspirin and unfactionated heparin or dalteparin. Baseline levels of creatinine, C-reactive protein (CRP), Troponin-T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were analysed. At selected sites, all patients received subcutaneous dalteparin (n=974), in stead of unfractionated heparin infusion (n=6826). In a sub-population of dalteparin treated patients (n=404), serial measurements of markers of inflammation , coagulation and fibrinolysis were also performed. Addition of abciximab to dalteparin as the primary treatment of unstable CAD was not associated with any significant reduction in cardiac events but a doubled risk of bleedings. The combination of abciximab and dalteparin seemed to be as safe as when used with unfractionated heparin. Despite full dose dalteparin and aspirin there was a simultaneous activation of the inflammation, coagulation and fibrinolysis systems without any influence of the abciximab treatment. Elevated levels of CRP, TnT, and NT-proBNP and reduced creatinine clearance were independently related to short and long-term mortality. The best prediction of high and low risk was provided by a combination of NT-proBNP and creatinine clearance. Any detectable elevation of TnT and reduced creatinine clearance, but neither elevation of CRP nor NT-proBNP, were also independently associated to a raised risk of subsequent myocardial infarction.

We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated. TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (&lt;/≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes. We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis. Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.

El elevado riesgo tromboembólico y hemorrágico en la fibrilación auricular (FA) es altamente heterogéneo y condiciona la morbi-mortalidad de la FA. La anticoagulación oral previene eventos trombóticos y mortalidad, pero conlleva ciertos riesgos. Por ello, los pacientes son estratificados según escalas de riesgo, que se intentan refinar adicionando otros marcadores. Para evaluar su utilidad pronóstica, puntuamos según las escalas CHA2DS2-VASc y HAS-BLED a pacientes consecutivos, anticoagulados de forma estable. Además determinamos los títulos de troponina T (hsTnT) e interleukina 6 ultrasensibles (hsIL6), y el índice tobillo brazo (ITB). La escala CHA2DS2-VASc predice eventos cardiovasculares y mortalidad; la escala HAS-BLED no solo es útil en la valoración del riesgo hemorrágico sino que también muestra valor predictivo de eventos cardiovasculares y mortalidad. Los valores de hsTnT y los de hsIL6 añaden información pronóstica, mejorando el índice de discriminación integrado de ambas escalas. El ITB resultó predictor de eventos trombóticos y hemorrágicos / The high thrombotic risk determines the atrial fibrillation morbi-mortality. Oral anticoagulation results in stroke and mortality prevention, at the expense of bleeding-related risk. These risks are highly heterogeneous, reason why patients are stratified according to risk scores, refined by specific biomarkers. In order to evaluate their prognostic value, we recruited consecutive patients, steady on oral anticoagulation, in whom CHA2DS2-VASc and HAS-BLED scores were calculated. In addition levels of high sensitivity troponin T and interleukin 6 (hsTnT and hsIL6 respectively) were determined, and the ankle brachial index (ABI) measured. The CHA2DS2-VASc score predicts cardiovascular events and mortality; HAS-BLED score is not only useful to assess bleeding risk but also shows predictive value for cardiovascular events and mortality. In addition levels of both hsTnT and hsIL6 provided prognostic information, improving the integrated discrimination index of both scores. Abnormal ABI was an independent predictor for all-cause mortality and major bleeding.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Introduction: Type 2 diabetes continues to be one of the most common non-communicable diseases worldwide and complications due to type 2 diabetes, such as cardiovascular disease (CVD) can cause severe disability and even death. Despite advances in the development and validation of cardiovascular risk scores, those used in clinical practice perform inadequately for people with type 2 diabetes. Research has suggested that particular non-traditional biomarkers and novel omics data may provide additional value to risk scores over-and-above traditional predictors. Aims: To determine whether a small panel of non-traditional biomarkers improve prediction models based on a current cardiovascular risk score (QRISK2), either individually or in combination, in people with type 2 diabetes. Furthermore, to investigate a set of 228 metabolites and their associations with CVD, independent of well-established cardiovascular risk factors, in order to identify potential new predictors of CVD for future research. Methods: Analyses used the Edinburgh Type 2 Diabetes Study (ET2DS), a prospective cohort of 1066 men and women with type 2 diabetes aged 60-75 years at baseline. Participants were followed for eight years, during which time 205 had a cardiovascular event. Additionally, for omics analyses, four cohorts from the UCL-LSHTM-Edinburgh-Bristol (UCLEB) consortium were combined with the ET2DS. Across all studies, 1005 (44.73%) participants had CVD at baseline or experienced a cardiovascular event during follow-up. Results: In the ET2DS, higher levels of high sensitivity cardiac troponin (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower levels of ankle brachial pressure index (ABI) were associated with incident cardiovascular events, independent of QRISK2 and pre-existing cardiovascular disease (odds ratios per one SD increase in biomarker 1.35 (95% CI: 1.13, 1.61), 1.23 (1.02, 1.49) and 0.86 (0.73, 1.00) respectively). The addition of each biomarker to a model including just QRISK2 variables improved the c-statistic, with the biggest increase for hs-cTnT (from 0.722 (0.681, 0.763) to 0.732 (0.690, 0.774)). When multiple biomarkers were considered in combination, the greatest c-statistic was found for a model which included ABI, hs-cTnT and gamma-glutamyl transpeptidase (0.740 (0.699, 0.781)). In the combined cohorts from the UCLEB consortium, a small number of high-density lipoprotein (HDL) particles were found to be significantly associated with CVD: concentration of medium HDL particles, total lipids in medium HDL, phospholipids in medium HDL and phospholipids in small HDL. These associations persisted after adjustment for a range of traditional cardiovascular risk factors including age, sex, blood pressure, smoking and HDL to total cholesterol ratio. Conclusions: In older people with type 2 diabetes, a range of non-traditional biomarkers increased predictive ability for cardiovascular events over-and-above the commonly used QRISK2 score, and a combination of biomarkers may provide the best improvement. Furthermore, a small number of novel omics biomarkers were identified which may further improve risk scores or provide better prediction than traditional lipid measurements such as HDL cholesterol.

Introdução: A liberação de biomarcadores de necrose miocárdica após a intervenção coronária percutânea (ICP) ocorre frequentemente. No entanto, a correlação entre a liberação dos biomarcadores e o diagnóstico do infarto agudo do miocárdio (IAM) tipo 4a tem gerado controvérsia, especialmente com o aumento da sensibilidade nos ensaios de troponina (Tn). Neste estudo, objetivamos quantificar a liberação dos biomarcadores cardíacos em pacientes submetidos à ICP eletiva sem o surgimento de novo realce tardio pelo gadolínio (RTG) na ressonância magnética cardíaca (RMC) após o procedimento. Métodos: Foram incluídos pacientes consecutivos com doença arterial coronária estável e função ventricular preservada, com indicação eletiva para ICP em pelo menos duas artérias epicárdicas. RMC com RTG foi realizada em todos os pacientes antes e depois das intervenções. Medidas seriadas de Tn e creatinoquinase fração MB (CK-MB) foram realizadas imediatamente antes do procedimento até 48 horas após. Pacientes com novo RTG na RMC após o procedimento foram excluídos. Resultados: 71 pacientes foram referenciados para a realização eletiva da ICP sendo que 15 (21,1%) foram excluídos, 10 (14,1%) por causa do surgimento de um novo RTG na RMC após a ICP. Nos 56 pacientes sem a evidência de IAM tipo 4a pela RMC predominava o gênero masculino 37 (66,1%) com idade média de 61,7 (± 8,4) anos e escore de SYNTAX médio de 16,6 (± 7,7). Após a ICP, 48 (85,1%) pacientes apresentaram um pico de elevação de Tn acima do percentil 99 sendo que em 32 (57,1%) a elevação foi superior a 5 vezes esse limite, enquanto que apenas 2 (3,6%) apresentaram um pico de CK-MB maior do que 5 vezes o percentil 99. A mediana do pico de liberação da Tn foi de 0,290 (0,061 - 1,09) ng/mL, valor 7,25 vezes superior ao percentil 99. Conclusão: Diferentemente da CK-MB, a liberação da troponina I ocorre com frequência após procedimento de ICP mesmo na ausência de realce tardio pelo gadolínio na ressonância magnética cardíaca / Background: The release of myocardial necrosis biomarkers after percutaneous coronary intervention (PCI) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedurerelated myocardial infarction (MI) (type 4a) has been controversial. This study aims to evaluate the amount and pattern of cardiac biomarker release after elective PCI in patients without the image of a new MI after the procedure assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Methods: Patients with normal baseline cardiac biomarkers referred for elective PCI were prospectively included. CMR with LGE was performed in all of the patients before and after the interventions. Measurements of troponin I (TnI) and creatinekinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. Results: Of the 56 patients without the evidence of a procedure-related MI assessed by the CMR after PCI, 48 (85.1%) exhibited a TnI elevation peak above the 99th percentile. In 32 (57.1%), the peak was greater than 5 times this limit. On the other hand, 17 (30.4%) had a CK-MB peak above the limit of the 99th percentile, and this peak was greater than 5 times the 99th percentile in only 2 patients (3.6%). The median peak release of TnI was 0.290 (0.061 to 1.09) ng/ml, which is 7.25-fold higher than the 99th percentile. Conclusions: In contrast to CK-MB, TnI release often occurs after an elective PCI procedure, despite the absence of a new LGE on CMR

Abstract Coronary artery disease (CAD) is the leading cause of death in developed countries. In patients with complex CAD, coronary artery bypass grafting (CABG) remains the preferred treatment as it can provide long-lasting results. However, CABG carries a significant risk of excessive perioperative bleeding and other complications, which may deteriorate the prognosis. Transfusion of blood products is generally used to compensate blood loss. However, both bleeding and blood transfusions have been shown to be associated with an adverse outcome. This cohort study aimed to clarify the impact of perioperative bleeding and the use of different blood products in the development of perioperative complications in 2,764 patients undergoing isolated CABG. The universal definition of perioperative bleeding classification (UDPB) was employed to stratify the severity of bleeding. Additionally, the impact of storage time of transfused red blood cells (RBCs) on the outcome was investigated. Increased UDPB classes, particularly classes 3 and 4, were associated with significantly poorer immediate and late outcome. RBC transfusion in patients who underwent elective off-pump CABG was independently associated with increased troponin I release indicating myocardial injury. Prolonged storage duration of transfused RBCs did not affect immediate and late outcome of patients with moderate bleeding. The most remarkable risk factors for stroke after off-pump CABG were any degree of atherosclerosis of the ascending aorta as well as transfusion of platelets and/or solvent/detergent-treated plasma. The UDPB classification appears to be a promising research tool to stratify the severity of perioperative bleeding and to assess its prognostic impact after coronary surgery. Prevention of major bleeding that leads to blood transfusion may protect from myocardial injury and stroke and possibly result in better early and late outcomes. Patients with a diseased ascending aorta could be considered at high risk of stroke because of their risk of generalized atherosclerosis. In case of mildly diseased aorta, the “no-touch” aorta policy should be considered with the intention of preventing postoperative stroke. / Tiivistelmä Sepelvaltimotauti on yleisin kuolinsyy kehittyneissä maissa. Potilailla, joilla on vaikea monen suonen tai vasemman sepelvaltimon päärungon tauti, sepelvaltimoiden ohitusleikkaus on edelleen paras hoitovaihtoehto, koska sillä pystytään saavuttamaan pitkäkestoisia tuloksia. Kuitenkin ohitusleikkaukseen liittyy suuri riski leikkauksen aikaiselle tai jälkeiselle verenvuodolle ja muille haittatapahtumille, jotka osaltaan huonontavat potilaan ennustetta. Vuodon hoitona käytetään yleisesti verensiirtoa. Kuitenkin on osoitettu, että sekä verenvuoto että verituotteiden anto lisäävät riskiä komplikaatioille. Tämän kohorttitutkimuksen tavoitteena oli selvittää tarkemmin leikkauksen yhteydessä ilmenevän vuodon ja siihen liittyvän verensiirron vaikutuksia leikkauksen jälkeisten haittatapahtumien kehittymiseen 2764 ohitusleikatulla potilaalla. Universal Definition of Perioperative Bleeding (UDPB) -luokitusta käytettiin vuodon vaikeusasteen luokittelemiseen. Lisäksi tutkittiin siirrettyjen punasolujen varastointiajan vaikutusta potilaan ennusteeseen. Korkeammat UDPB-luokat, erityisesti luokat 3 ja 4, liittyivät merkittävästi huonompaan lyhyen ja pitkän aikavälin ennusteeseen. Potilailla, joille oli tehty kiireetön ohitusleikkaus ilman sydän-keuhkokoneen käyttöä, punasolujen anto oli itsenäinen riskitekijä suurentuneelle troponiini I -päästölle eli sydänlihasvauriolle. Pidentynyt punasolujen varastointiaika ei ollut yhteydessä lyhyen tai pitkän aikavälin ennusteeseen potilailla, jotka olivat vuotaneet kohtalaisesti. Merkittävimmät riskitekijät ilman sydän-keuhkokonetta tehdyn leikkauksen jälkeiselle aivoinfarktille olivat minkä tahansa asteinen nousevan aortan ateroskleroosi sekä verihiutaleiden ja/tai jääplasman anto. UDPB-luokitus vaikuttaa lupaavalta tutkimustyökalulta verenvuodon vaikeusasteen luokitteluun. Lisäksi sitä voidaan käyttää vuodon ennusteellisen vaikutuksen arvioimiseen ohitusleikkauksen jälkeen. Runsaan verenvuodon ja siihen liittyvän verensiirron ehkäiseminen saattaa suojata potilasta sydänlihasvauriolta ja aivoinfarktilta ja mahdollisesti johtaa parempaan lyhyen ja pitkän aikavälin ennusteeseen. Potilaita, joilla on nousevan aortan ateroskleroosi, voisi pitää suuressa aivoinfarktiriskissä yleisen ateroskleroosiriskin vuoksi. Potilailla, joilla on lieväkin nousevan aortan ateroskleroosi, tulisi harkita aortan jättämistä pihdittämättä aivoinfarktin ehkäisemiseksi.

Introdução: A liberação de biomarcadores de necrose miocárdica após revascularização miocárdica cirúrgica (RM) ocorre com frequência. No entanto, a correlação entre a liberação de biomarcadores e o diagnóstico do infarto agudo do miocárdio (IAM) periprocedimento gera controvérsias, especialmente com o aumento da sensibilidade nos ensaios de troponina (Tn). Neste estudo, objetivou-se quantificar a liberação dos biomarcadores cardíacos em pacientes submetidos à RM, sem o uso de circulação extra corpórea (CEC), que não apresentaram evidências de infarto do miocárdio por meio da avaliação do realce tardio pelo gadolínio (RTG) na ressonância magnética cardíaca (RMC). Métodos: Pacientes portadores de doença arterial coronária estável e função ventricular preservada, com indicação eletiva para RM sem CEC, foram incluídos. RMC com RTG foi realizada em todos os pacientes antes e depois do procedimento. Aferições seriadas de Tn e creatinoquinase fração MB (CK-MB) foram realizadas antes do procedimento e até 72h após. Pacientes com RTG na RMC após o procedimento foram excluídos. Resultados: 73 pacientes foram referenciados para a realização eletiva da RM sem CEC e 20 (27%) foram excluídos, 14 (19%) por causa do surgimento de um novo RTG na RMC. Dentre os 53 pacientes sem evidência de IAM periprocedimento pela RMC, 37 (70%) eram do gênero masculino, a média da idade foi 63 (± 10) anos e o escore SYNTAX médio encontrado foi 20 (±7). Após a RM, todos os pacientes apresentaram um pico de elevação de Tn acima do percentil 99; em 48 (91%) pacientes a elevação foi superior a 10 vezes esse limite. Por outro lado, 41 (76%) pacientes apresentaram pico de CK-MB acima do percentil 99 e em apenas 7 (13%) este pico foi superior à10 vezes o percentil 99. A mediana do pico de liberação da Tn foi 2,0 (0,8 - 3,7) ng/mL, valor 50 vezes superior ao percentil 99. Conclusão: Diferente da CK-MB, a liberação da troponina I ocorre, frequentemente, após procedimento de RM sem CEC na ausência de realce tardio pela RMC / Background: The release of myocardial necrosis biomarkers after off-pump coronary artery bypass grafting (OPCAB) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedurerelated myocardial infarction (MI) (type 5) has been controversial. This study aims to evaluate the amount and pattern of cardiac biomarker release after elective OPCAB in patients without the image of a new MI assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). Methods: Patients with normal baseline cardiac biomarkers referred for elective OPCAB were prospectively included. CMR with LGE was performed in all patients before and after interventions. Measurements of troponin I (cTnI) and creatinekinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. Results: Of the 53 patients without the evidence of a procedure-related MI assessed by the CMR after OPCAB, all patients exhibited cTnI elevation peak above the 99th percentile. In 48 (91%), the peak value was greater than 10 times this threshold. However, 41 (76%) had CK-MB peak above the limit of the 99th percentile, and this peak was greater than 10 times the 99th percentile in only 7 patients (13%). The median peak release of cTnI was 0.20 (0.8 - 3.7) ng/mL, which is 50-fold higher than the 99th percentile. Conclusions: In contrast to CK-MB, cTnI release often occurs after an elective OPCAB procedure, despite the absence of a new LGE on CMR

Background Coronavirus Disease-2019 (COVID-19) affected elderly individuals disproportionately in terms of hospitalization and adverse outcome. Objective This cross-sectional study examined the associations of COVID-19 diagnosis (COVID-negative versus COVID-positive) with levels of four clinical markers – cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), D-dimer and b-type natriuretic peptide (NT-proBNP) – along with potential differences in associations by sex in a hospital-based sample of elderly individuals. Methods The sample comprised individuals aged ≥80 years visiting the Emergency at Karolinska universitetssjukhuset (Huddinge) between January 2020 and December 2021 for whom data on polymerase chain reaction-based COVID-19 testing were available (n=2668). Plasma levels of the markers were measured using standard methods. Right skewed outcome variables were natural-log (Ln) transformed. Multivariable linear regression models were fitted. Results Participants’ median age was 87 years (interquartile range: 85–90) and 58.4% were female. Approximately 13% of the participants were COVID-19 positive. There was no statistically significant association between COVID-positive diagnosis and any of the markers after controlling for age and sex. On sex stratification, COVID-19 positive males had 55.3% (95% confidence interval (CI): 1.1%–138.4%; P=0.044) higher hsCRP levels than COVID-negative males. Additionally, age was positively associated with cTnT (Ln cTnT βadjusted: 0.041; 95% CI: 0.033–0.050; P&lt;0.001) and NT-proBNP (Ln NTproBNP βadjusted: 0.059; 95% CI: 0.015–0.102; P=0.008). Conclusion COVID-positive diagnosis was not related with the markers apart from a sex-specific, positive association with hsCRP observed among males. Future studies should explore the relationship of these markers with mortality to determine their prognostic utility among elderly individuals.