{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:21Z","timestamp":1787028921095,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG) remains difficult to diagnose due to varying biomarker thresholds and ECG criteria. This study aimed to evaluate the predictive value of ECG changes and cardiac biomarkers for identifying pathological findings in repeat coronary angiography after CABG. Materials and Methods: This retrospective study included 137 patients who underwent repeat coronary angiography due to suspected PMI. ECG changes and serial measurements of CK, CK-MB, and hsTnT were analyzed at 4, 8, and 18 h postoperatively. The primary endpoint was the identification of graft-related complications or new coronary lesions. Results: Pathological angiographic findings were detected in 85.4% (n = 117) of cases, predominantly graft-related complications (96.6%). ST-segment elevation (p &lt; 0.01) and ST-segment depression (p = 0.02) were significantly associated with pathological findings. The combination of ST-segment elevation and CK-MB &gt; 1.0 \u00b5kat\/L also showed a high predictive accuracy (p &lt; 0.01). HsTnT demonstrated the strongest diagnostic performance, with a threshold of 1231 ng\/L at 18 h (AUC = 1.0; p &lt; 0.01). Earlier postoperative biomarker elevations did not show significant discriminatory value. Conclusions: ECG remains the most accessible and fastest predictive tool for PMI detection. However, cardiac biomarkers only gain diagnostic relevance beyond 8 h postoperatively. A multimodal approach integrating biomarker kinetics and ECG changes may enhance early decision-making and improve patient outcomes, as ST-segment elevation in combination with CK-MB &gt; 1.0 \u00b5kat\/L serves as a relevant predictor. Notably, hsTnT levels &gt; 1231 ng\/L at 18 h reliably identified patients with pathological angiographic findings. These findings were derived from a highly selected cohort (~2% of all CABG patients) referred for coronary angiography and should therefore be interpreted as hypothesis-generating rather than directly generalizable to the broader surgical population.<\/jats:p>","DOI":"10.3390\/medicina61122192","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T12:57:41Z","timestamp":1765457861000},"page":"2192","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Electrocardiogram-Alterations and Increasing Cardiac Enzymes After Coronary Artery Bypass Grafting\u2014When Can We Expect Significant Findings in Coronary Angiography?"],"prefix":"10.3390","volume":"61","author":[{"given":"Ali","family":"Taghizadeh-Waghefi","sequence":"first","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3382-1142","authenticated-orcid":false,"given":"Manuel","family":"Wilbring","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6827-2489","authenticated-orcid":false,"given":"Asen","family":"Petrov","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Arzt","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utz","family":"Kappert","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sems-Malte","family":"Tugtekin","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-3967","authenticated-orcid":false,"given":"Klaus","family":"Matschke","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Alexiou","sequence":"additional","affiliation":[{"name":"Medical Faculty \u201cCarl Gustav Carus\u201d, Technical University of Dresden, 01307 Dresden, Germany"},{"name":"Center for Minimally Invasive Cardiac Surgery, University Heart Center Dresden, 01307 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.amjcard.2008.04.069","article-title":"Impact of perioperative myocardial infarction on angiographic and clinical outcomes following coronary artery bypass grafting (from project of ex-vivo vein graft engineering via transfection [prevent] iv)","volume":"102","author":"Yau","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1093\/icvts\/ivx317","article-title":"Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: A single-centre experience","volume":"26","author":"Preusser","year":"2018","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13019-018-0710-0","article-title":"Control angiography for perioperative myocardial ischemia after coronary surgery: Meta-analysis","volume":"13","author":"Biancari","year":"2018","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e001027","DOI":"10.1136\/openhrt-2019-001027","article-title":"Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery","volume":"6","author":"Sef","year":"2019","journal-title":"Open Heart"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/eurheartj\/ehac604","article-title":"Cardiac troponin release following coronary artery bypass grafting: Mechanisms and clinical implications","volume":"44","author":"Heuts","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1093\/eurheartj\/ehx383","article-title":"Esc joint working groups on cardiovascular surgery and the cellular biology of the heart position paper: Perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery","volume":"38","author":"Thielmann","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4170","DOI":"10.1093\/eurheartj\/ehae416","article-title":"Great debate: Myocardial infarction after cardiac surgery must be redefined","volume":"45","author":"Gaudino","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_8","first-page":"e618","article-title":"Executive Group on behalf of the Joint European Society of Cardiology\/American College of Cardiology\/American Heart Association\/World Heart Federation Task Force for the Universal Definition of Myocardial, Fourth universal definition of myocardial infarction","volume":"138","author":"Thygesen","year":"2018","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.jacc.2013.08.720","article-title":"Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (scai)","volume":"62","author":"Moussa","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","first-page":"433","article-title":"Periprocedural myocardial infarction and injury","volume":"13","author":"Spagnolo","year":"2024","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_11","first-page":"2135","article-title":"2025 acc\/aha\/acep\/naemsp\/scai guideline for the management of patients with acute coronary syndromes: A report of the american college of cardiology\/american heart association joint committee on clinical practice guidelines","volume":"85","author":"Rao","year":"2025","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 esc guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ezad415","DOI":"10.1093\/ejcts\/ezad415","article-title":"European association of cardio-thoracic surgery (eacts) expert consensus statement on perioperative myocardial infarction after cardiac surgery","volume":"65","author":"Gaudino","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1161\/CIR.0000000000001154","article-title":"Considerations on the management of acute postoperative ischemia after cardiac surgery: A scientific statement from the american heart association","volume":"148","author":"Gaudino","year":"2023","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2020.08.009","article-title":"Impact of peri-procedural myocardial infarction on outcomes after revascularization","volume":"76","author":"Hara","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","first-page":"100591","article-title":"Correlation between periprocedural myocardial infarction, mortality, and quality of life in coronary revascularization trials: A meta-analysis","volume":"2","author":"Gaudino","year":"2023","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1378\/chest.121.1.103","article-title":"Use of biochemical markers of infarction for diagnosing perioperative myocardial infarction and early graft occlusion after coronary artery bypass surgery","volume":"121","author":"Holmvang","year":"2002","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1055\/s-0035-1564927","article-title":"The unplanned postoperative coronary angiogram after cabg: Identifying the patients at risk","volume":"65","author":"Fleissner","year":"2017","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/S1010-7940(01)00692-3","article-title":"Early angiographic control of perioperative ischemia after coronary artery bypass grafting","volume":"19","author":"Fabricius","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.ahj.2004.08.016","article-title":"Indications for angiography subsequent to coronary artery bypass grafting","volume":"149","author":"Alter","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ejcts.2006.03.062","article-title":"Emergency re-revascularization with percutaneous coronary intervention, reoperation, or conservative treatment in patients with acute perioperative graft failure following coronary artery bypass surgery","volume":"30","author":"Thielmann","year":"2006","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/icvts\/ivr127","article-title":"Management of early postoperative coronary artery bypass graft failure","volume":"14","author":"Laflamme","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13019-019-0876-0","article-title":"Impact of coronary angiography early after cabg for suspected postoperative myocardial ischemia","volume":"14","author":"Rupprecht","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S1010-7940(97)00268-6","article-title":"Significance and management of early graft failure after coronary artery bypass grafting: Feasibility and results of acute angiography and re-re-vascularization","volume":"12","author":"Rasmussen","year":"1997","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S226","DOI":"10.1161\/CIRCULATIONAHA.112.000347","article-title":"Impact of expeditious management of perioperative myocardial ischemia in patients undergoing isolated coronary artery bypass surgery","volume":"128","author":"Davierwala","year":"2013","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S1010-7940(98)00091-8","article-title":"Are electrocardiographic q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?","volume":"13","author":"Svedjeholm","year":"1998","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.ejcts.2004.02.030","article-title":"Clinical significance of a new q wave after cardiac surgery","volume":"25","author":"Crescenzi","year":"2004","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jtcvs.2004.06.005","article-title":"Increased creatine kinase mb level predicts postoperative mortality after cardiac surgery independent of new q waves","volume":"129","author":"Ramsay","year":"2005","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0003-4975(99)01294-1","article-title":"Troponin levels in patients with myocardial infarction after coronary artery bypass grafting","volume":"69","author":"Carrier","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1007\/s00059-004-2543-y","article-title":"Comparison of cardiac troponin i versus t and creatine kinase mb after coronary artery bypass grafting in patients with and without perioperative myocardial infarction","volume":"29","author":"Peivandi","year":"2004","journal-title":"Herz"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1161\/CIRCULATIONAHA.124.070729","article-title":"Prognostic relevance of type 4a myocardial infarction and periprocedural myocardial injury in patients with non-st-segment-elevation myocardial infarction","volume":"151","author":"Armillotta","year":"2025","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.jacc.2023.07.011","article-title":"Association of high-sensitivity cardiac troponin t with 30-day and 5-year mortality after cardiac surgery","volume":"82","author":"Polzl","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1056\/NEJMoa2000803","article-title":"High-sensitivity troponin i after cardiac surgery and 30-day mortality","volume":"386","author":"Devereaux","year":"2022","journal-title":"N. Engl. J. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2192\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:22:29Z","timestamp":1765459349000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122192"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122192","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}