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Are electrocardiogr...
Are electrocardiographic Q-wave criteria reliable for diagnosis of perioperative myocardial infarction after coronary surgery?
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- Svedjeholm, Rolf (författare)
- Östergötlands Läns Landsting,Kardiologiska kliniken
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- Dahlin, Lars-Göran (författare)
- Östergötlands Läns Landsting,Kardiologiska kliniken
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- Lundberg, Claes (författare)
- Östergötlands Läns Landsting,Kardiologiska kliniken
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- Szabo, Zoltan (författare)
- Department of Cardiothoracic Surgery, Debrecen, Hungary
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- Kågedal, Bertil (författare)
- Linköpings universitet,Klinisk kemi,Hälsouniversitetet
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- Nylander, Eva (författare)
- Östergötlands Läns Landsting,Fysiologiska kliniken
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- Olin, Christian (författare)
- Östergötlands Läns Landsting,Kardiologiska kliniken
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- Rutberg, Hans (författare)
- Östergötlands Läns Landsting,Kardiologiska kliniken
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(creator_code:org_t)
- 1998
- 1998
- Engelska.
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Ingår i: European Journal of Cardio-Thoracic Surgery. - 1010-7940 .- 1873-734X. ; 13:6, s. 655-661
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Objective: A major assumption in cardiovascular medicine is that Q-waves on the electrocardiogram indicate major myocardial tissue damage. The appearance of a new Q-wave has therefore been considered the most reliable criterion for diagnosis of perioperative myocardial infarction (PMI) in cardiac surgery. In a study, originally intended to evaluate troponin-T as a marker of PMI, analysis of our data aroused the need to address the reliability of Q-wave criteria for diagnosis of PMI.Methods: In 302 consecutive patients undergoing coronary surgery, Q-wave and other electrocardiogram (ECG) criteria were compared with biochemical markers of myocardial injury and the postoperative course. All ECGs were analysed by a cardiologist blinded to the biochemical analyses and the clinical course.Results: The incidence of positive Q-wave criteria was 8.1%. Combined biochemical (CK-MB≥70 μg/l) and Q-wave criteria were found in 1.0%. Patients with new Q-waves did not have CK-MB or troponin-T levels significantly different from those without Q-waves. More than 25% of the Q-waves were associated with plasma troponin-T below the reference level (<0.2 μg/l) on the fourth postoperative day. Q-wave criteria alone did not influence the postoperative course. In contrast, biochemical markers correlated with clinical outcome.Conclusions: The majority of Q-waves appearing after coronary surgery were not associated with major myocardial tissue damage, and according to troponin-T one-fourth of the Q-waves were not associated with myocardial necrosis. Furthermore, the appearance of Q-waves had little influence on short term clinical outcome. Therefore, the use of Q-wave criteria as the gold standard for diagnosis of PMI may have to be questioned.
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- MEDICINE
- MEDICIN
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- art (ämneskategori)
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